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NPI Code Detail

MEDICARE: KENNETH HAGGARD PHD, LCDP

MEDICARE: KENNETH HAGGARD PHD, LCDP
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1295013472
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH HAGGARD PHD, LCDP
Provider Business Mailing Address
First Line : 1052 PARK AVE
Second Line :
City : CRANSTON
State : RI
Zip : 02910-3225
Country : US
Telephone Number : 401-461-5056
Fax Number :
Provider Business Practice Location Address
First Line : 1052 PARK AVE
Second Line :
City : CRANSTON
State : RI
Zip : 02910-3225
Country : US
Telephone Number : 401-461-5056
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2011
Last Update Date : 02/06/2026

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