Provider Demographics
NPI:1477678894
Name:THOMAS KENNEDY
Entity Type:Organization
Organization Name:THOMAS KENNEDY
Other - Org Name:CORNERSTONE PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:NEEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-730-8877
Mailing Address - Street 1:10808 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3622
Mailing Address - Country:US
Mailing Address - Phone:410-730-8877
Mailing Address - Fax:410-997-0396
Practice Address - Street 1:10808 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:410-730-8877
Practice Address - Fax:410-997-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD230PMedicare ID - Type UnspecifiedGROUP NUMBER