Provider Demographics
NPI:1588470744
Name:KENNEDY, CAPRICE EVE NIKA
Entity type:Individual
Prefix:
First Name:CAPRICE
Middle Name:EVE NIKA
Last Name:KENNEDY
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 1:510 MALONEY RD APT K16
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5909
Mailing Address - Country:US
Mailing Address - Phone:845-541-9220
Mailing Address - Fax:
Practice Address - Street 1:510 MALONEY RD APT K16
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-5909
Practice Address - Country:US
Practice Address - Phone:845-541-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P130152-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health