Healthcare Provider Details

I. General information

NPI: 1104973494
Provider Name (Legal Business Name): REGINA KENNEDY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ORANGE ST FORENSIC MENTAL HEALTH
RIVERSIDE CA
92501-3613
US

IV. Provider business mailing address

PO BOX 3081
RIVERSIDE CA
92519-3081
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4545
  • Fax: 951-955-2138
Mailing address:
  • Phone: 951-539-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: