Provider Demographics
NPI:1043461007
Name:KENNEDY, MARY PANAHI (MA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:PANAHI
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8933
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-5933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 N BROOKHURST ST
Practice Address - Street 2:#320
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5226
Practice Address - Country:US
Practice Address - Phone:714-490-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health