MEDICARE: ALEXANDRA KENNEDY MS, LAC, NCC, CPRP

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	101YM0800X	Mental Health Counselor	37PC01182200	NJ

General Provider Information

NPI Number	:	1790555803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA KENNEDY MS, LAC, NCC, CPRP

Provider Business Mailing Address
First Line	:	99 SPRUCE MILL LN
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-3179
Country	:	US
Telephone Number	:	732-710-0281
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 SPRUCE MILL LN
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-3179
Country	:	US
Telephone Number	:	732-710-0281
Fax Number	:

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

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	03/14/2026

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