Provider Demographics
NPI:1679001465
Name:KENNARD, AINSLEY (PSYD)
Entity Type:Individual
Prefix:
First Name:AINSLEY
Middle Name:
Last Name:KENNARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 NE 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-5432
Mailing Address - Country:US
Mailing Address - Phone:954-918-2443
Mailing Address - Fax:
Practice Address - Street 1:1975 E SUNRISE BLVD STE 511
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1409
Practice Address - Country:US
Practice Address - Phone:954-999-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9835103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical