Provider Demographics
NPI:1982836771
Name:KENNARD, ELIZABETH NORAH
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:NORAH
Last Name:KENNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ROSS-KENNARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:38 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1927
Mailing Address - Country:US
Mailing Address - Phone:415-322-6117
Mailing Address - Fax:
Practice Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 375
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3041
Practice Address - Country:US
Practice Address - Phone:415-322-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health