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General NPI Number Information
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NPI Number | 1356779912
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Entity Type | Individual
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Provider Name | JULIA MARIE KENNEDY PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 01/26/2020
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Provider Practice Location Address
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Address Line | 3939 SAN PEDRO DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-8900
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Country | US
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Telephone | 505-379-2709
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Fax |
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Provider Business Mailing Address
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Address Line | 25 FISCHER LN
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City | TIJERAS
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State | NM
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Zip | 87059-8203
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Country | US
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Telephone | 505-379-2709
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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 | 1084
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License Number State | NM
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