Provider Demographics
NPI:1255665030
Name:KENNEDY-ARENIVAR, BRIAN ERIC (LMHC, LPC-S)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ERIC
Last Name:KENNEDY-ARENIVAR
Suffix:
Gender:M
Credentials:LMHC, LPC-S
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:ERIC
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S, LMHC
Mailing Address - Street 1:125 E 23RD ST STE 402
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4547
Mailing Address - Country:US
Mailing Address - Phone:917-590-1211
Mailing Address - Fax:
Practice Address - Street 1:125 E 23RD ST STE 402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4547
Practice Address - Country:US
Practice Address - Phone:646-984-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NY011500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX63604OtherSTATE BOARD LICENSE
NY011500OtherSTATE BOARD LICENSE