Provider Demographics
NPI:1508250895
Name:KENEFICK, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KENEFICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 WESTBROOK RD STE 7
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1553
Mailing Address - Country:US
Mailing Address - Phone:860-608-5474
Mailing Address - Fax:
Practice Address - Street 1:158 WESTBROOK RD STE 7
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1553
Practice Address - Country:US
Practice Address - Phone:860-608-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program