Provider Demographics
NPI:1619182227
Name:KENNEDY, SHEILA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:M
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2633
Mailing Address - Country:US
Mailing Address - Phone:215-248-7104
Mailing Address - Fax:215-753-3662
Practice Address - Street 1:9701 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2633
Practice Address - Country:US
Practice Address - Phone:215-248-7104
Practice Address - Fax:215-753-3662
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009098L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist