Provider Demographics
NPI:1972208130
Name:KENNEDY, ELAINE (MS)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 FRENSHAM CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2856
Mailing Address - Country:US
Mailing Address - Phone:410-807-1300
Mailing Address - Fax:
Practice Address - Street 1:5211 AUTH RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4339
Practice Address - Country:US
Practice Address - Phone:202-257-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health