Provider Demographics
NPI:1629482518
Name:KENNEY, NICOLE MARIE (PSYCHOLOGY, BS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:PSYCHOLOGY, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CLIVE ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1039
Mailing Address - Country:US
Mailing Address - Phone:732-829-1837
Mailing Address - Fax:
Practice Address - Street 1:447 W 47TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2453
Practice Address - Country:US
Practice Address - Phone:732-829-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator