Provider Demographics
NPI:1619338209
Name:JOHN F. KENNEDY UNIVERSITY
Entity Type:Organization
Organization Name:JOHN F. KENNEDY UNIVERSITY
Other - Org Name:JFKU COMMUNITY COUNSELING CENTER - SUNNYVALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSLEY-DAME
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:925-798-9240
Mailing Address - Street 1:2702 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2789
Mailing Address - Country:US
Mailing Address - Phone:925-798-9240
Mailing Address - Fax:
Practice Address - Street 1:572 DUNHOLME WAY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3300
Practice Address - Country:US
Practice Address - Phone:408-524-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty