Provider Demographics
NPI:1790944551
Name:KENNEDY, MERCEDES (MA EDM LPC)
Entity Type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MA EDM LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 NASSAU STREET OFFICE #28
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542
Mailing Address - Country:US
Mailing Address - Phone:609-683-1300
Mailing Address - Fax:609-683-1361
Practice Address - Street 1:195 NASSAU STREET OFFICE #28
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542
Practice Address - Country:US
Practice Address - Phone:609-683-1300
Practice Address - Fax:609-683-1361
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00242300103T00000X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily