Healthcare Provider Details

I. General information

NPI: 1386595197
Provider Name (Legal Business Name): SEAN KENNEDY RMHCI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 SOUTHPARK CIR E
ST AUGUSTINE FL
32086-5137
US

IV. Provider business mailing address

12 FERN ST
ST AUGUSTINE FL
32084-1240
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-6680
  • Fax:
Mailing address:
  • Phone: 310-729-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number32579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: