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General NPI Number Information
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NPI Number | 1518229632
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Entity Type | Individual
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Provider Name | ROSALIA KENNEDY MSED BCBA
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Gender | Female
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 3506 169TH ST APT D5
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City | FLUSHING
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State | NY
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Zip | 11358-1843
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Country | US
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Telephone | 516-639-9451
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Fax |
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Provider Business Mailing Address
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Address Line | 3506 169TH ST APT D5
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City | FLUSHING
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State | NY
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Zip | 11358-1843
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Country | US
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Telephone |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 820852
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License Number State | NY
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