Provider Demographics
NPI:1073747507
Name:KENNEDY, DANIEL (PSYD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHRISTY DR
Mailing Address - Street 2:STE 207
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9667
Mailing Address - Country:US
Mailing Address - Phone:609-970-0640
Mailing Address - Fax:
Practice Address - Street 1:65 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2424
Practice Address - Country:US
Practice Address - Phone:609-970-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00376400101YP2500X
NJ521800103TC0700X
PAPSO17612103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional