Provider Demographics
NPI:1275786410
Name:KENNINGTON, NEAL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:J
Last Name:KENNINGTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14441 W MCDOWELL RD
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2519
Mailing Address - Country:US
Mailing Address - Phone:602-292-2881
Mailing Address - Fax:
Practice Address - Street 1:14441 W MCDOWELL RD
Practice Address - Street 2:SUITE B-102
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2519
Practice Address - Country:US
Practice Address - Phone:602-292-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical