Provider Demographics
NPI:1134149214
Name:KENNY, JAMES ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDREW
Last Name:KENNY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W HARRISON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2839
Mailing Address - Country:US
Mailing Address - Phone:219-866-7869
Mailing Address - Fax:219-866-0688
Practice Address - Street 1:219 W HARRISON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2839
Practice Address - Country:US
Practice Address - Phone:219-866-7869
Practice Address - Fax:219-866-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3238880002/PROV 10OtherMAGELLAN PROVIDER NUMBER
IN445OtherARNETT PROVIDER NUMBER
IN000000186895OtherANTHEM PROVIDER NUMBER
IN391580Medicare ID - Type UnspecifiedPROVIDER NUMBER