Healthcare Provider Details

I. General information

NPI: 1912088618
Provider Name (Legal Business Name): DOREEN A. KENNEDY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3734 JUSTISON RD
COCONUT GROVE FL
33133-6133
US

IV. Provider business mailing address

3734 JUSTISON RD
COCONUT GROVE FL
33133-6133
US

V. Phone/Fax

Practice location:
  • Phone: 305-282-8791
  • Fax: 305-661-2081
Mailing address:
  • Phone: 305-282-8791
  • Fax: 305-661-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: