Provider Demographics
NPI:1053009464
Name:HAVERLAND, KENNEDY (LMSW)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:HAVERLAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 GENERAL CHENNAULT ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2515
Mailing Address - Country:US
Mailing Address - Phone:505-900-3833
Mailing Address - Fax:505-212-6422
Practice Address - Street 1:126 GENERAL CHENNAULT ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2515
Practice Address - Country:US
Practice Address - Phone:505-900-3833
Practice Address - Fax:505-212-6422
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-0035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker