Provider Demographics
NPI:1932480894
Name:KENNEDY, JOHN THOMAS (EDD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 SKIFF MOUNTAIN RD
Mailing Address - Street 2:PO BOX 3001
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-1112
Mailing Address - Country:US
Mailing Address - Phone:860-927-0047
Mailing Address - Fax:
Practice Address - Street 1:476 SKIFF MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1112
Practice Address - Country:US
Practice Address - Phone:860-927-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health