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NPI Code Detail

MEDICARE: DR. DAVID R. KENIS PH. D.

MEDICARE: DR. DAVID R. KENIS PH. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist20040382IN
2103TB0200XCognitive & Behavioral Psychologist
3103TC0700XClinical Psychologist20040382IN
4103TC2200XClinical Child & Adolescent Psychologist
5103TF0000XFamily Psychologist
6103TF0200XForensic Psychologist
7103TP2701XGroup Psychotherapy Psychologist

General Provider Information

NPI Number : 1023007853
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID R. KENIS PH. D.
Provider Business Mailing Address
First Line : 354 WORCHESTER DR
Second Line : APT. 8-B
City : VALPARAISO
State : IN
Zip : 46383-1333
Country : US
Telephone Number : 219-531-3500
Fax Number : 219-462-3975
Provider Business Practice Location Address
First Line : 601 WALL ST
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-2512
Country : US
Telephone Number : 219-531-3500
Fax Number : 219-462-3975
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 09/11/2025

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