MEDICARE: M.J. KENNEDY, PH.D. INCORPORATED

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	22127	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184818965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.J. KENNEDY, PH.D. INCORPORATED

Provider Business Mailing Address
First Line	:	16846 ROYAL CREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2529
Country	:	US
Telephone Number	:	281-480-9291
Fax Number	:	281-218-6116

Provider Business Practice Location Address
First Line	:	16846 ROYAL CREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2529
Country	:	US
Telephone Number	:	281-480-9291
Fax Number	:	281-218-6116

Authorized Official
Title or Position	:	OWNER
Name	:	MARTHA J KENNEDY
Credential	:	PH.D.
Telephone Number	:	281-480-9291

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	09/05/2007

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Directions to “M.J. KENNEDY, PH.D. INCORPORATED ” Practice Location

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