Healthcare Provider Details

I. General information

NPI: 1366889651
Provider Name (Legal Business Name): JEFFREY G KENNEDY MA, LPCC, CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 HAMILTON AVE SUITE 206
CINCINNATI OH
45231-6103
US

IV. Provider business mailing address

11440 HAMILTON AVE SUITE 206
CINCINNATI OH
45231-6103
US

V. Phone/Fax

Practice location:
  • Phone: 513-648-9596
  • Fax: 513-648-9586
Mailing address:
  • Phone: 513-648-9596
  • Fax: 513-648-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.120697
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1200140
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: