Individual
DR. MARY LYNNE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21 PEACE ST, PROVIDENCE, RI 02907-1510
(401) 456-3309
Mailing address
200 HIGH SERVICE AVE, NORTH PROVIDENCE, RI 02904-5113
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PS00572
RI
103T00000X
Psychologist
PS00572
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS00572
LICENSE NUMBER
RI
Enumeration date
11/24/2006
Last updated
09/27/2007
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