Provider Demographics
NPI:1932486107
Name:KENNEDY, CRAIG MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:MICHAEL
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WATERVLIET SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1002
Mailing Address - Country:US
Mailing Address - Phone:518-464-6300
Mailing Address - Fax:
Practice Address - Street 1:1292 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROTTERDAM JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12150-9741
Practice Address - Country:US
Practice Address - Phone:518-464-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028361-1101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool