Provider Demographics
NPI:1225293178
Name:KENNEDY, WENDY M (MFT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:M
Other - Last Name:TKACHUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1711
Mailing Address - Country:US
Mailing Address - Phone:707-272-4102
Mailing Address - Fax:
Practice Address - Street 1:3 VERNON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1711
Practice Address - Country:US
Practice Address - Phone:707-272-4102
Practice Address - Fax:707-467-1362
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1858101YM0800X
CAMFC 45904106H00000X
VT100.0134012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health