Provider Demographics
NPI:1629137021
Name:KENNEDY, NANCY L (LMHC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 BAYVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631
Mailing Address - Country:US
Mailing Address - Phone:508-255-8418
Mailing Address - Fax:
Practice Address - Street 1:50 LONG POND RD
Practice Address - Street 2:SO BAY MENTAL HEALTH
Practice Address - City:YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664
Practice Address - Country:US
Practice Address - Phone:508-398-5277
Practice Address - Fax:508-398-4959
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health