Provider Demographics
NPI:1326670571
Name:KENNEDY, VERONICA MARIE (AMFT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:MARIE
Other - Last Name:ESPINOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10270 E TARON DR APT 88
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8225
Mailing Address - Country:US
Mailing Address - Phone:951-751-1600
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-781-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist