Healthcare Provider Details

I. General information

NPI: 1952807562
Provider Name (Legal Business Name): BRIAN KENNEDY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 LAKEWOOD RD STE 200
TOMS RIVER NJ
08755-1211
US

IV. Provider business mailing address

1901 LAKEWOOD RD STE 200
TOMS RIVER NJ
08755-1211
US

V. Phone/Fax

Practice location:
  • Phone: 732-505-4612
  • Fax:
Mailing address:
  • Phone: 732-505-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00614200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: