Organization
KENNEDY MEDICAL GROUP PRACTICE P.C.
Active
Other names
Kennedy Health Alliance
Organization subpart
No
Provider details
NPI number
Authorized official
CARMAN A CIERVO D.O. (CPE)
(856) 344-7360
Entity
Organization
Contact information
Practice address
900 ROUTE 168, SUITE C#3, BLACKWOOD, NJ 08012-3233
(856) 857-6920
Mailing address
900 ROUTE 168, SUITE C#3, BLACKWOOD, NJ 08012-3233
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0411248
—
NJ
Enumeration date
02/28/2017
Last updated
02/28/2017
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