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General NPI Number Information
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NPI Number | 1053572958
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Entity Type | Organization
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Legal Business Name | KENNEDY KRIEGER ASSOCIATES, INC.
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 707 N. BROADWAY
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City | BALTIMORE
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State | MD
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Zip | 21205
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Country | US
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Telephone | 443-923-9200
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Fax | 443-923-9405
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Provider Business Mailing Address
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Address Line | P.O. BOX 744865
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City | ATLANTA
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State | GA
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Zip | 30374
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Country | US
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Telephone | 443-923-1886
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Fax | 443-923-1895
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Authorized Official
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Title or Position | VICE PRESIDENT FINANCE
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Name | MR. MIKE NEUMAN
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Credential |
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Telephone | 443-923-1810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 30036
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License Number State | MD
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