Healthcare Provider Details

I. General information

NPI: 1902977283
Provider Name (Legal Business Name): KEVIN MICHAEL KENNEY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BROADHOLLOW RD STE 120
MELVILLE NY
11747-4863
US

IV. Provider business mailing address

667 STONELEIGH AVE STE 202
CARMEL NY
10512-2455
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015632
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: