Provider Demographics
NPI:1982235727
Name:KENON, MARCI
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:KENON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 5TH AVE APT 25E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3127
Mailing Address - Country:US
Mailing Address - Phone:646-389-0063
Mailing Address - Fax:479-777-8056
Practice Address - Street 1:101 W 123RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5511
Practice Address - Country:US
Practice Address - Phone:646-389-0063
Practice Address - Fax:479-777-8056
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302388405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional