Provider Demographics
NPI:1598976128
Name:KENNY, MICHAL MIRA (MA)
Entity Type:Individual
Prefix:MS
First Name:MICHAL
Middle Name:MIRA
Last Name:KENNY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CHELMSFORD STREET
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2307
Mailing Address - Country:US
Mailing Address - Phone:781-729-0633
Mailing Address - Fax:
Practice Address - Street 1:201 CHELMSFORD STREET
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2307
Practice Address - Country:US
Practice Address - Phone:978-256-1467
Practice Address - Fax:978-256-7465
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health