Individual
MS. IDA ROSE KENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
601 BROADWAY, BAYONNE, NJ 07002-3818
(201) 339-9200
(201) 339-7842
Mailing address
601 BROADWAY, BAYONNE, NJ 07002-3818
(201) 339-9200
(201) 339-7842
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37PC00281600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0021806
—
NJ
Enumeration date
10/20/2009
Last updated
10/20/2009
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