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General NPI Number Information
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NPI Number | 1174503247
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Entity Type | Individual
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Provider Name | MARTHA J KENNEDY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16846 ROYAL CREST DR
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City | HOUSTON
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State | TX
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Zip | 77058-2529
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Country | US
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Telephone | 281-480-9291
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Fax |
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Provider Business Mailing Address
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Address Line | 450 KIRBY
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City | SEABROOK
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State | TX
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Zip | 77586
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Country | US
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Telephone | 281-480-9291
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22127
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License Number State | TX
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