Healthcare Provider Details

I. General information

NPI: 1841115995
Provider Name (Legal Business Name): ROBERTA CALLAHAN KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ALBANY ST
BOSTON MA
02119-2560
US

IV. Provider business mailing address

801 ALBANY ST
BOSTON MA
02119-2560
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-3825
  • Fax: 617-638-5795
Mailing address:
  • Phone: 617-414-3825
  • Fax: 617-638-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: