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General NPI Number Information
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NPI Number | 1376078568
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Entity Type | Individual
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Provider Name | CAITLIN BREE KENNEDY D.AC., L.AC
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Gender | Female
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 99 GRAND AVE STE 4
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4908
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Country | US
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Telephone | 516-884-5215
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Fax |
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Provider Business Mailing Address
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Address Line | 133 ROOSEVELT AVENUE
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762
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Country | US
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Telephone | 516-884-5215
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 005786
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License Number State | NY
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