Provider Demographics
NPI:1780811307
Name:REA, PARKER KENNEDY (PSYD)
Entity type:Individual
Prefix:DR
First Name:PARKER
Middle Name:KENNEDY
Last Name:REA
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 1:21 COURT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2812
Mailing Address - Country:US
Mailing Address - Phone:202-730-6955
Mailing Address - Fax:
Practice Address - Street 1:21 COURT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2812
Practice Address - Country:US
Practice Address - Phone:202-730-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000547103TC0700X
103TC2200X
VT048.0128109103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent