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General NPI Number Information
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NPI Number | 1083434997
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Entity Type | Individual
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Provider Name | TIARRA KENNEDY MD
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1829 REISTERSTOWN RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-6320
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Country | US
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Telephone | 443-704-6777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 67656
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City | BALTIMORE
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State | MD
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Zip | 21215-0017
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Country | US
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Telephone | 443-704-6777
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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Taxonomy #5
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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Taxonomy #7
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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Taxonomy #8
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State | MD
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Taxonomy #9
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State |
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