Provider Demographics
NPI:1023238904
Name:KENNEDY, MARLA CATHERINE (MA LP LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:CATHERINE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MA LP LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2259 SUMMIT AVE.
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1002
Mailing Address - Country:US
Mailing Address - Phone:651-645-3303
Mailing Address - Fax:
Practice Address - Street 1:4103 EAST LAKE ST.
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2259
Practice Address - Country:US
Practice Address - Phone:651-645-6020
Practice Address - Fax:651-645-6020
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1248103TC1900X
MN0666106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP36121OtherHEALTH PARTNERS OLD
MN0666OtherMARRIAGE AND FAMILY LICEN
MN72325277000Medicaid
MNLP1248OtherPSYCHOLOGY LICENSE
MNBC 1GO74KEOtherBLUE CROSS