MEDICARE: DR. MARTHA J KENNEDY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	22127	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174503247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA J KENNEDY PH.D.

Provider Business Mailing Address
First Line	:	450 KIRBY
Second Line	:
City	:	SEABROOK
State	:	TX
Zip	:	77586
Country	:	US
Telephone Number	:	281-480-9291
Fax Number	:

Provider Business Practice Location Address
First Line	:	16846 ROYAL CREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2529
Country	:	US
Telephone Number	:	281-480-9291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/08/2007

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