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General NPI Number Information
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NPI Number | 1316022015
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Entity Type | Individual
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Provider Name | MAUREEN CAROLYN KENNEDY PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1 VETERANS DR
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City | MINNEAPOLIS
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State | MN
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Zip | 55417-2309
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Country | US
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Telephone | 612-725-2000
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Fax | 612-467-2144
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Provider Business Mailing Address
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Address Line | 4293 DEERWOOD LN N
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City | PLYMOUTH
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State | MN
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Zip | 55441-1909
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Country | US
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Telephone | 763-551-0316
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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 | 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 #2
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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