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General NPI Number Information
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NPI Number | 1518492800
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Entity Type | Organization
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Legal Business Name | PARKER KENNEDY REA PSYD PLLC
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 21 COURT ST SUITE 2
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City | MONTPELIER
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State | VT
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Zip | 05602-2812
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Country | US
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Telephone | 202-730-6955
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Fax |
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Provider Business Mailing Address
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Address Line | 21 COURT ST SUITE 2
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City | MONTPELIER
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State | VT
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Zip | 05602-2812
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Country | US
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Telephone | 202-730-6955
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. PARKER KENNEDY REA
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Credential | PSYD
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Telephone | 202-730-6955
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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 | 048.0128109
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License Number State | VT
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