Provider Demographics
NPI:1700016474
Name:KENNEDY, CRAIG (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 APPLETON PL
Mailing Address - Street 2:BOX 228, VANDERBILT UNIVERSITY
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5721
Mailing Address - Country:US
Mailing Address - Phone:615-322-8150
Mailing Address - Fax:615-343-1570
Practice Address - Street 1:230 APPLETON PL
Practice Address - Street 2:BOX 228, VANDERBILT UNIVERSITY
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5721
Practice Address - Country:US
Practice Address - Phone:615-322-8150
Practice Address - Fax:615-343-1570
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-02-0797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst