Provider Demographics
NPI:1295584241
Name:KENNETT, KENNETH DANIEL
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DANIEL
Last Name:KENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ADMIRAL CIR APT B
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-5671
Mailing Address - Country:US
Mailing Address - Phone:225-288-2895
Mailing Address - Fax:
Practice Address - Street 1:107 ADMIRAL CIR APT B
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-5671
Practice Address - Country:US
Practice Address - Phone:225-288-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst