Healthcare Provider Details

I. General information

NPI: 1740127661
Provider Name (Legal Business Name): LAUREN KENNEDY MS, CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6723 TOWPATH RD
EAST SYRACUSE NY
13057-9506
US

IV. Provider business mailing address

234 TURK RD
WILLIAMSTOWN NY
13493-2141
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-1004
  • Fax:
Mailing address:
  • Phone: 315-532-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: