Individual provider Active NPI

Mary E Kennedy, LCSW

  • Clinical Social Worker
  • Louisville, KY
National Provider Identifier
1750567178
Registry record updated Sep 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
3375 Issued in KY
Practice address
4710 Champions Trace LN
107
Louisville, KY 40218-3495
Phone
(502) 589-8600
Fax
(502) 589-8771
NPI assigned
Jan 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 3375 KY Primary

Addresses

Primary practice location

4710 Champions Trace LN
107
Louisville, KY 40218-3495

Mailing address

10101 Linn Station Rd Ste 600
Louisville, KY 40223-3818

Other names 1

  • Mary E Kennedy-Carr Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151027000739 KY Practitioner - Clinical Social Worker 3072822386 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3375KYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Seven Counties Services, Inc. Clinical CurrentSince Aug 25, 2015 Accepting new patients

Locations

18 Alexander Ave
Ste C
Bedford, KY 40006

684 Elm St
Eminence, KY 40019
Phone (501) 661-1444

530 S Jackson St
Louisville, KY 40202
Phone (502) 562-3000

4710 Champions Trace Ln
Ste 102
Louisville, KY 40218
Phone (502) 454-6343

914 E Broadway
Louisville, KY 40204
Phone (502) 587-8833

10101 Linn Station Rd
Ste 600
Louisville, KY 40223
Phone (502) 858-9860

101 W Muhammad Ali Blvd
Louisville, KY 40202
Phone (502) 589-8615

10401 Linn Station Rd
Ste 100
Louisville, KY 40223

4710 Champions Trace Ln
Ste 107
Louisville, KY 40218
Phone (502) 454-6343

805 Mary St
Louisville, KY 40204

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505865600000",
    "number": "1750567178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10101 LINN STATION RD STE 600",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402233818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4710 CHAMPIONS TRACE LN",
            "address_2": "107",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402183495",
            "telephone_number": "502-589-8600",
            "fax_number": "502-589-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-16",
        "last_updated": "2017-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "3375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "KENNEDY-CARR",
            "middle_name": "E",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.