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General NPI Number Information
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NPI Number | 1083964381
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Entity Type | Individual
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Provider Name | KATHERINE ROSE KENNEDY BARRY MA
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Gender | Female
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 3504 COMMERCIAL AVE
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City | NORTHBROOK
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State | IL
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Zip | 60062-1821
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Country | US
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Telephone | 847-272-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 W MONTANA ST 2
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City | CHICAGO
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State | IL
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Zip | 60614-2221
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Country | US
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Telephone | 608-295-2830
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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 | 178.008171
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License Number State | IL
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