Individual
MRS. CHANIN LEE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
3041 UNIVERSITY AVE, SUITE 5, MORGANTOWN, WV 26505-3362
(304) 598-0809
Mailing address
PO BOX 4425, MORGANTOWN, WV 26504-4425
(304) 598-0809
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
807
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9202219000
—
WV
Enumeration date
10/27/2006
Last updated
07/09/2007
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