Provider Demographics
NPI:1720598105
Name:KENNEDY, BRANDY R (MS)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:R
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6903
Mailing Address - Country:US
Mailing Address - Phone:337-534-0770
Mailing Address - Fax:337-534-4370
Practice Address - Street 1:113 W CONVENT ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6903
Practice Address - Country:US
Practice Address - Phone:337-534-0770
Practice Address - Fax:337-534-4370
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health