Provider Demographics
NPI:1770864944
Name:BEDOYA, KENNY
Entity Type:Individual
Prefix:
First Name:KENNY
Middle Name:
Last Name:BEDOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 HEWES ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-8111
Mailing Address - Country:US
Mailing Address - Phone:718-532-1060
Mailing Address - Fax:718-218-8264
Practice Address - Street 1:267 HEWES ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8111
Practice Address - Country:US
Practice Address - Phone:718-532-1060
Practice Address - Fax:718-218-8264
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor