Provider Demographics
NPI:1952807562
Name:KENNEDY, BRIAN (LPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 LAKEWOOD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1211
Mailing Address - Country:US
Mailing Address - Phone:732-505-4612
Mailing Address - Fax:
Practice Address - Street 1:1901 LAKEWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1211
Practice Address - Country:US
Practice Address - Phone:732-505-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00614200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional