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General NPI Number Information
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NPI Number | 1518843929
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Entity Type | Individual
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Provider Name | FAMATA KENNEDY
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Gender | Female
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 29 N MAIN STREET
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City | MILLBURY
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State | MA
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Zip | 01527
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Country | US
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Telephone | 508-475-5676
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Fax |
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Provider Business Mailing Address
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Address Line | 197 EVERETT ST APT 1L
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550-2646
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Country | US
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Telephone | 774-420-4750
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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