Provider Demographics
NPI:1073718334
Name:KENNEDY, THERESA ANN REDONDO (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN REDONDO
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2425 ENBORG LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2648
Mailing Address - Country:US
Mailing Address - Phone:408-885-4077
Mailing Address - Fax:
Practice Address - Street 1:2425 ENBORG LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2648
Practice Address - Country:US
Practice Address - Phone:408-885-4077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical