Provider Demographics
NPI:1386033140
Name:KENNEDY, APRYL DIANE
Entity Type:Individual
Prefix:
First Name:APRYL
Middle Name:DIANE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1908
Mailing Address - Country:US
Mailing Address - Phone:408-445-3400
Mailing Address - Fax:408-998-8043
Practice Address - Street 1:602 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1908
Practice Address - Country:US
Practice Address - Phone:408-445-3400
Practice Address - Fax:408-998-8043
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)