Provider Demographics
NPI:1518229632
Name:KENNEDY, ROSALIA (MSED BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 169TH ST
Mailing Address - Street 2:APT D5
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3506 169TH ST
Practice Address - Street 2:APT D5
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1843
Practice Address - Country:US
Practice Address - Phone:516-639-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY820852174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY820852OtherSPECIAL EDUCATION TEACHER