Provider Demographics
NPI:1679093397
Name:KENNEDY, KATHRYN MARIE (BCABA)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 EWELL CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-1961
Mailing Address - Country:US
Mailing Address - Phone:843-494-2087
Mailing Address - Fax:
Practice Address - Street 1:119 EWELL CT
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-1961
Practice Address - Country:US
Practice Address - Phone:843-494-2087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst