Provider Demographics
NPI:1326585027
Name:KENNEDY, MAUREEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1833
Mailing Address - Country:US
Mailing Address - Phone:516-294-0522
Mailing Address - Fax:
Practice Address - Street 1:42 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1833
Practice Address - Country:US
Practice Address - Phone:516-294-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016161-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist