Provider Demographics
NPI:1033851613
Name:KENNEDY, EMILY (MS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 COLORCOTT ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7864
Mailing Address - Country:US
Mailing Address - Phone:984-355-0928
Mailing Address - Fax:
Practice Address - Street 1:711 SILVERMINE RD
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4329
Practice Address - Country:US
Practice Address - Phone:888-822-8436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator