Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | PC008599 | PA |
N | 101YP1600X | Pastoral Counselor | PC008599 | PA |
NPI | 1366805459 |
---|---|
Provider Name | Dr. Christine Kennedy |
First Address | Glenside, PA 19038-7508 |
Second Address | Jenkintown, PA 19046-3145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2016 |
Last Update Date | 05/04/2016 |