Provider Demographics
NPI:1700392289
Name:KENNEDY, ANGEL MARIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:MARIE
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:542 HOPMEADOW ST # 129
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-5405
Mailing Address - Country:US
Mailing Address - Phone:413-262-3721
Mailing Address - Fax:
Practice Address - Street 1:351 PLEASANT ST STE B126
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-262-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-17-27211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst