Individual
DEREK KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
177 E 122ND ST, NEW YORK, NY 10035-2906
(212) 360-7116
Mailing address
177 E 122ND ST, NEW YORK, NY 10035-2906
(212) 360-7116
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18393
NY
Other
Enumeration date
12/31/2014
Last updated
12/31/2014
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