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General NPI Number Information
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NPI Number | 1528575081
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Entity Type | Individual
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Provider Name | SANDRA KENNY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 5838 EDISON PL STE 100
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City | CARLSBAD
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State | CA
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Zip | 92008-5520
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Country | US
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Telephone | 805-962-8179
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Fax |
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Provider Business Mailing Address
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Address Line | 602 ANACAPA ST
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City | SANTA BARBARA
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State | CA
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Zip | 93101-1615
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Country | US
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Telephone | 805-962-8179
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 12588-15
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License Number State | ZZ
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