Provider Demographics
NPI:1336684034
Name:KENNAMAR-LINN LLC
Entity Type:Organization
Organization Name:KENNAMAR-LINN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNAMER-LINN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-622-9603
Mailing Address - Street 1:3350 BURBERRY PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8754
Mailing Address - Country:US
Mailing Address - Phone:407-622-9603
Mailing Address - Fax:321-805-4915
Practice Address - Street 1:3350 BURBERRY PL
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-8754
Practice Address - Country:US
Practice Address - Phone:407-622-9603
Practice Address - Fax:321-805-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13013305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization