=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588992481
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUREEN THERESA HENNESSEY PHD, CPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2009
-----------------------------------------------------
Last Update Date | 12/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1229 W 62ND ST APT 1
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64113-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-363-4220
-----------------------------------------------------
Fax | 816-363-4220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1229 W 62ND ST APT 1
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64113-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-363-4220
-----------------------------------------------------
Fax | 816-363-4220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 01014
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071.004619
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1031
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------