Healthcare Provider Details

I. General information

NPI: 1245758424
Provider Name (Legal Business Name): KAYDEN KENNEDY
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: KARINA KARLSEN

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 10/26/2026
Certification Date: 10/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 S MAIN ST STE 215
FALL RIVER MA
02721-5375
US

IV. Provider business mailing address

73 BARRETT ST APT 2060
NORTHAMPTON MA
01060-1710
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: