Provider Demographics
NPI:1811292832
Name:KENNEY, CHRISTINE JOAN (CADC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JOAN
Last Name:KENNEY
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:JOAN
Other - Last Name:BACHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAC
Mailing Address - Street 1:55 SKYLARK DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06472-1232
Mailing Address - Country:US
Mailing Address - Phone:203-484-4619
Mailing Address - Fax:
Practice Address - Street 1:1268 MAIN ST
Practice Address - Street 2:SUITE #101
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3038
Practice Address - Country:US
Practice Address - Phone:203-484-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT574101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)