MEDICARE: HILARIE FOTTER KENNEDY

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
1	103T00000X	Psychologist	PS2447	ME

General Provider Information

NPI Number	:	1144900432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILARIE FOTTER KENNEDY

Provider Business Mailing Address
First Line	:	31 FOREST LN
Second Line	:
City	:	CUMBERLAND
State	:	ME
Zip	:	04021-3046
Country	:	US
Telephone Number	:	207-491-9947
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 FOREST LN
Second Line	:
City	:	CUMBERLAND
State	:	ME
Zip	:	04021-3046
Country	:	US
Telephone Number	:	207-491-9947
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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Directions to “ HILARIE FOTTER KENNEDY ” Practice Location

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