Healthcare Provider Details

I. General information

NPI: 1629412861
Provider Name (Legal Business Name): REBECCA ELLEN KENNEDY LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. REBECCA ELLEN DUPUY

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

IV. Provider business mailing address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

V. Phone/Fax

Practice location:
  • Phone: 207-660-4549
  • Fax: 207-660-4529
Mailing address:
  • Phone: 207-660-4549
  • Fax: 207-660-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: