| Doctor Name: | MS. JAMIE COSTELLO KENWOOD |
| NPI Number: | 1316113525 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 23573 |
| Business Practice Address: | Prison Rd California State Prison Sacramento Represa, CA - 95670 |
| Business Phone Number: | 9163246317 |
| Business Fax Number: | 9162943195 |
| Mailing Address: | Po Box 290010, REPRESA |
| State: | CA |
| Postal Code: | 956710010 |
| Phone Number: | 9163246317 |
| Fax Number: | 9162943195 |
| NPI Enumeration Date: | 05/07/2008 |
| NPI Last Update Date: | 05/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 23573 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |