Provider Demographics
NPI:1750717781
Name:KENNEDY, KARYN (BCBA)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WASHINGTON ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2710
Mailing Address - Country:US
Mailing Address - Phone:888-355-3255
Mailing Address - Fax:
Practice Address - Street 1:50 WASHINGTON ST
Practice Address - Street 2:SUITE 502
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2710
Practice Address - Country:US
Practice Address - Phone:888-355-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-12-12146103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst