Provider Demographics
NPI:1962723973
Name:KENNEDY, KERI LYN
Entity type:Individual
Prefix:MS
First Name:KERI
Middle Name:LYN
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 1:10 WILSEY SQ
Mailing Address - Street 2:SUITE 262
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3792
Mailing Address - Country:US
Mailing Address - Phone:201-251-3800
Mailing Address - Fax:
Practice Address - Street 1:10 WILSEY SQ
Practice Address - Street 2:SUITE 262
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3792
Practice Address - Country:US
Practice Address - Phone:201-251-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst