Provider Demographics
NPI:1891214862
Name:KENNEDY, RAKIAH LASHAE (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MS
First Name:RAKIAH
Middle Name:LASHAE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 FILLMORE ST STE 216
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4164
Mailing Address - Country:US
Mailing Address - Phone:415-963-4149
Mailing Address - Fax:
Practice Address - Street 1:1426 FILLMORE ST STE 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4164
Practice Address - Country:US
Practice Address - Phone:415-563-8017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101Y00000XMedicaid