Provider Demographics
NPI:1982969143
Name:KENNEDY, KAREN L (LMHC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14730 SCOTTBURGH GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-6206
Mailing Address - Country:US
Mailing Address - Phone:941-777-4617
Mailing Address - Fax:
Practice Address - Street 1:14730 SCOTTBURGH GLEN DR
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-6206
Practice Address - Country:US
Practice Address - Phone:941-777-4617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health