Individual
MR. MICHAEL KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDP
Contact information
Practice address
55 CHERRY LN, WAKEFIELD, RI 02879-3617
(401) 364-7705
(401) 364-9104
Mailing address
4705A OLD POST RD, CHARLESTOWN, RI 02813-1819
(401) 364-7705
(401) 364-9104
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30342
BLUE CROSS
RI
05
—
GH57134
—
RI
05
—
MK76619
—
RI
Enumeration date
08/15/2008
Last updated
04/28/2011
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