Provider Demographics
NPI:1942653142
Name:KENNEDY BEHAVORIAL HEALTH
Entity Type:Organization
Organization Name:KENNEDY BEHAVORIAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER'S LEVEL CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:856-582-1419
Mailing Address - Street 1:454 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2339
Mailing Address - Country:US
Mailing Address - Phone:856-582-1419
Mailing Address - Fax:856-582-7661
Practice Address - Street 1:454 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2339
Practice Address - Country:US
Practice Address - Phone:856-582-1419
Practice Address - Fax:856-582-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00294300261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health