Provider Demographics
NPI:1871335935
Name:KENNEY-TOLENTINO, SOPHIA (PCSW)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:KENNEY-TOLENTINO
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E GRAND AVE UNIT 13
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5268
Mailing Address - Country:US
Mailing Address - Phone:785-341-3212
Mailing Address - Fax:
Practice Address - Street 1:2900 E GRAND AVE UNIT 13
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5268
Practice Address - Country:US
Practice Address - Phone:785-341-3212
Practice Address - Fax:844-868-3535
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-1162104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker