Provider Demographics
NPI:1467579607
Name:KENNEDY, LOWELL THEODORE (MAJOR)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:THEODORE
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MAJOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 W SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-3318
Mailing Address - Country:US
Mailing Address - Phone:215-329-9679
Mailing Address - Fax:215-235-3311
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor