Provider Demographics
NPI:1083388573
Name:BARKAN-KENNEDY, ANDREA (AMFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BARKAN-KENNEDY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 SCHOONER DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4323
Mailing Address - Country:US
Mailing Address - Phone:805-697-5133
Mailing Address - Fax:
Practice Address - Street 1:305 E MATILIJA ST # 201F
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2768
Practice Address - Country:US
Practice Address - Phone:805-697-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health