Provider Demographics
NPI:1578688453
Name:KENNEDY, MICHAELA (LPC, HHP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 WHITE CLOUD RD
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-8434
Mailing Address - Country:US
Mailing Address - Phone:412-820-2050
Mailing Address - Fax:
Practice Address - Street 1:1431 WHITE CLOUD RD
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-8434
Practice Address - Country:US
Practice Address - Phone:412-820-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional