Provider Demographics
NPI:1376670752
Name:KENNEDY, LOIS ROCHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:ROCHELLE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 WEST 23RD ST
Mailing Address - Street 2:14F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1444
Mailing Address - Country:US
Mailing Address - Phone:212-633-6110
Mailing Address - Fax:
Practice Address - Street 1:445 WEST 23RD ST
Practice Address - Street 2:# 1BB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1444
Practice Address - Country:US
Practice Address - Phone:212-255-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0071801103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical