Provider Demographics
NPI:1386344711
Name:KENNY, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COCHRANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19330-9490
Mailing Address - Country:US
Mailing Address - Phone:610-755-7288
Mailing Address - Fax:
Practice Address - Street 1:601 GAY ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3852
Practice Address - Country:US
Practice Address - Phone:610-755-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional