Provider Demographics
NPI:1295942209
Name:KENNEDY, LAURA PRICE (PSYD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PRICE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:28 MCBRIDE PLACE
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2107
Mailing Address - Country:US
Mailing Address - Phone:845-294-3757
Mailing Address - Fax:845-294-5337
Practice Address - Street 1:28 MCBRIDE PLACE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2107
Practice Address - Country:US
Practice Address - Phone:845-294-3757
Practice Address - Fax:845-294-5337
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014134-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL8671Medicare ID - Type Unspecified