Provider Demographics
NPI:1366866535
Name:KENNEDY, PHILIPPE
Entity Type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 HOWARD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2650
Mailing Address - Country:US
Mailing Address - Phone:415-255-3977
Mailing Address - Fax:415-252-3008
Practice Address - Street 1:1380 HOWARD ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2650
Practice Address - Country:US
Practice Address - Phone:415-255-3977
Practice Address - Fax:415-252-3008
Is Sole Proprietor?:No
Enumeration Date:2014-02-09
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker
No174400000XOther Service ProvidersSpecialist