Individual
DR. MARY THERESA KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
217-04 NORTHERN BLVD, STE 16, BAYSIDE, NY 11361-3500
(718) 631-8939
Mailing address
218-11 HORACE HARDING BLVD, BAYSIDE, NY 11364-2211
(718) 631-8939
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
00760201
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01067481
—
NY
Enumeration date
12/22/2005
Last updated
09/03/2010
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