MEDICARE: KENRICK VINCENT

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1568319713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENRICK VINCENT

Provider Business Mailing Address
First Line	:	1 N MAIN ST APT 213
Second Line	:
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-4378
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 N MAIN ST
Second Line	:
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-4376
Country	:	US
Telephone Number	:	914-305-1324
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ KENRICK VINCENT ” Practice Location

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