MEDICARE: DR. LINDA T KENNEDY PHD

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	0861	NM

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	:	1396856258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA T KENNEDY PHD

Provider Business Mailing Address
First Line	:	PO BOX 236
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-0236
Country	:	US
Telephone Number	:	505-425-3155
Fax Number	:	505-425-3155

Provider Business Practice Location Address
First Line	:	509 11TH ST
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3958
Country	:	US
Telephone Number	:	505-425-3155
Fax Number	:	505-425-3155

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/31/2011

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Directions to “ DR. LINDA T KENNEDY PHD” Practice Location

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