Healthcare Provider Details

I. General information

NPI: 1629922661
Provider Name (Legal Business Name): KENNEDY ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CONSTITUTION DR STE 101
VIRGINIA BEACH VA
23462-3479
US

IV. Provider business mailing address

2 CONSTITUTION DR STE 101
VIRGINIA BEACH VA
23462-3479
US

V. Phone/Fax

Practice location:
  • Phone: 888-360-6664
  • Fax: 984-266-6765
Mailing address:
  • Phone: 888-360-6664
  • Fax: 984-266-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YITZCHOK ISSAC CZIMENT
Title or Position: DIRECTOR
Credential: CZIMENT
Phone: 888-360-6664