Healthcare Provider Details

I. General information

NPI: 1841329232
Provider Name (Legal Business Name): CLIVE DALE KENNEDY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1672 W AVENUE J STE 207
LANCASTER CA
93534-2861
US

IV. Provider business mailing address

1672 W AVENUE J STE 207
LANCASTER CA
93534-2861
US

V. Phone/Fax

Practice location:
  • Phone: 661-943-3871
  • Fax:
Mailing address:
  • Phone: 661-943-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 8011
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY 8011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: