MEDICARE: MICHELLE KENNEDY

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

General Provider Information

NPI Number	:	1992210744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KENNEDY

Provider Business Mailing Address
First Line	:	32 ACACIA AVE
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-1351
Country	:	US
Telephone Number	:	617-799-2607
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 HARTFORD ST
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461-1517
Country	:	US
Telephone Number	:	781-234-4200
Fax Number	:

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

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	12/01/2017

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Directions to “ MICHELLE KENNEDY ” Practice Location

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