Provider Demographics
NPI:1326448663
Name:KENNY, ALEXANDRA GRACE (RRW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GRACE
Last Name:KENNY
Suffix:
Gender:F
Credentials:RRW
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:GRACE
Other - Last Name:RADCLIFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:700 EL RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1511
Mailing Address - Country:US
Mailing Address - Phone:831-535-3884
Mailing Address - Fax:
Practice Address - Street 1:700 EL RANCHO DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1511
Practice Address - Country:US
Practice Address - Phone:831-535-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)