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General NPI Number Information
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NPI Number | 1932707445
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Entity Type | Individual
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Provider Name | KENNEDY TAMBI PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 64 MAIN ST APT 35B
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City | STONEHAM
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State | MA
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Zip | 02180-3384
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Country | US
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Telephone | 617-286-3364
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Fax |
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Provider Business Mailing Address
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Address Line | 64 MAIN ST APT 35B
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City | STONEHAM
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State | MA
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Zip | 02180-3384
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Country | US
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Telephone | 617-286-3364
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN237828
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License Number State | MA
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