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General NPI Number Information
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NPI Number | 1235338492
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Entity Type | Organization
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Legal Business Name | SUSAN KENNEDY LLC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 132 MORRILL RD
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City | CANTERBURY
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State | NH
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Zip | 03224-2305
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Country | US
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Telephone | 603-344-2212
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Fax |
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Provider Business Mailing Address
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Address Line | 132 MORRILL RD PO BOX 152
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City | CANTERBURY
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State | NH
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Zip | 03224-2305
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Country | US
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Telephone | 603-344-2212
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. SUSAN LILLIA KENNEDY
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Credential | LICSW
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Telephone | 603-344-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 397
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License Number State | NH
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