Provider Demographics
NPI:1164668034
Name:KENYON, LIBERTY (LMHC)
Entity Type:Individual
Prefix:
First Name:LIBERTY
Middle Name:
Last Name:KENYON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CROSSING DR APT 303
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4375
Mailing Address - Country:US
Mailing Address - Phone:401-935-7265
Mailing Address - Fax:
Practice Address - Street 1:190 CROSSING DR APT 303
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4375
Practice Address - Country:US
Practice Address - Phone:401-935-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI,HC00390101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid