Provider Demographics
NPI:1487678561
Name:KENNEDY, JOHN PATRICK (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 CROW CANYON RD STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1583
Mailing Address - Country:US
Mailing Address - Phone:925-831-8777
Mailing Address - Fax:925-831-8776
Practice Address - Street 1:2723 CROW CANYON RD STE 211
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1583
Practice Address - Country:US
Practice Address - Phone:925-831-8777
Practice Address - Fax:925-831-8776
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37151106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist