Provider Demographics
NPI:1235338492
Name:SUSAN KENNEDY LLC
Entity Type:Organization
Organization Name:SUSAN KENNEDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LILLIA
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-344-2212
Mailing Address - Street 1:132 MORRILL RD
Mailing Address - Street 2:PO BOX 152
Mailing Address - City:CANTERBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03224-2305
Mailing Address - Country:US
Mailing Address - Phone:603-344-2212
Mailing Address - Fax:
Practice Address - Street 1:132 MORRILL RD
Practice Address - Street 2:
Practice Address - City:CANTERBURY
Practice Address - State:NH
Practice Address - Zip Code:03224-2305
Practice Address - Country:US
Practice Address - Phone:603-344-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH397251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health