Provider Demographics
NPI:1588919393
Name:KENNEDY, DIANE M (MA - PSYCH)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MA - PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1841 FORT WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1909
Mailing Address - Country:US
Mailing Address - Phone:808-681-3500
Mailing Address - Fax:808-681-1486
Practice Address - Street 1:2970 KELE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1823
Practice Address - Country:US
Practice Address - Phone:808-245-5914
Practice Address - Fax:808-245-8040
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator