Provider Demographics
NPI:1588281083
Name:KENNEDY, KELLI (CMA, NAVIGATOR)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CMA, NAVIGATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3415
Mailing Address - Country:US
Mailing Address - Phone:973-570-4615
Mailing Address - Fax:
Practice Address - Street 1:526 WATER ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1310
Practice Address - Country:US
Practice Address - Phone:908-475-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)