Provider Demographics
NPI:1750544508
Name:KENNEDY, MARY L (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
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 1:910 S CHAPEL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3467
Mailing Address - Country:US
Mailing Address - Phone:302-224-1400
Mailing Address - Fax:302-224-1402
Practice Address - Street 1:910 S CHAPEL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3467
Practice Address - Country:US
Practice Address - Phone:302-224-1400
Practice Address - Fax:302-224-1402
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical