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General NPI Number Information
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NPI Number | 1013480367
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Entity Type | Individual
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Provider Name | KENNEDY ROTHENBUESCHER
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Gender | Female
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 10/29/2023
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Provider Practice Location Address
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Address Line | 3701 HACIENDA ST
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City | SAN MATEO
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State | CA
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Zip | 94403-4366
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Country | US
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Telephone | 650-539-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 MARINA VILLAGE PKWY STE 100
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City | ALAMEDA
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State | CA
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Zip | 94501-1078
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Country | US
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Telephone | 510-337-7950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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