Provider Demographics
NPI:1629412861
Name:KENNEDY, REBECCA ELLEN (LCPC-C)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ELLEN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:ELLEN
Other - Last Name:DUPUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:67 EUSTIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5173
Mailing Address - Country:US
Mailing Address - Phone:207-660-4549
Mailing Address - Fax:207-660-4529
Practice Address - Street 1:67 EUSTIS PKWY
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5173
Practice Address - Country:US
Practice Address - Phone:207-660-4549
Practice Address - Fax:207-660-4529
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional