Provider Demographics
NPI:1962432575
Name:KENNEDY, MONICA M (MD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:M
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 STATE ROAD
Mailing Address - Street 2:340
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-6402
Mailing Address - Country:US
Mailing Address - Phone:513-232-3400
Mailing Address - Fax:513-232-1900
Practice Address - Street 1:7495 STATE ROAD
Practice Address - Street 2:340
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6402
Practice Address - Country:US
Practice Address - Phone:513-232-3400
Practice Address - Fax:513-232-1900
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350531952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100043180Medicaid
OH000000278038OtherANTHEM
OH165950000OtherMAGELLAN
OH0644897Medicaid
P00612922Medicare PIN
KY0687713Medicare PIN
OHCO3302Medicare UPIN
OHKE066902Medicare PIN
OH0644897Medicaid