Healthcare Provider Details

I. General information

NPI: 1619309424
Provider Name (Legal Business Name): JOSEPH KENNEDY M.S.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 AUSTIN ST SUITE 200 CPSE
FOREST HILLS NY
11375
US

IV. Provider business mailing address

7000 AUSTIN ST SUITE 200 CPSE
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-7633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number501342
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number501342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: