Provider Demographics
NPI:1093490328
Name:KENNEDY, MARINDA CARLY (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:MARINDA
Middle Name:CARLY
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 W CULLOM AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1402
Mailing Address - Country:US
Mailing Address - Phone:312-671-3669
Mailing Address - Fax:
Practice Address - Street 1:3450 N LEAVITT ST UNIT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6014
Practice Address - Country:US
Practice Address - Phone:847-220-7298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health