Provider Demographics
NPI:1942643416
Name:KENNEDY, LISAMARIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:LISAMARIE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 RUSTIC DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6731
Mailing Address - Country:US
Mailing Address - Phone:850-879-1289
Mailing Address - Fax:
Practice Address - Street 1:1801 MICCOSUKEE COMMONS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5433
Practice Address - Country:US
Practice Address - Phone:850-921-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor