Provider Demographics
NPI:1366889651
Name:KENNEDY, JEFFREY G (MA, LPCC, CDCA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:G
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MA, LPCC, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 HAMILTON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-6103
Mailing Address - Country:US
Mailing Address - Phone:513-648-9596
Mailing Address - Fax:513-648-9586
Practice Address - Street 1:11440 HAMILTON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-6103
Practice Address - Country:US
Practice Address - Phone:513-648-9596
Practice Address - Fax:513-648-9586
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1200140101YM0800X
OHCDCA.120697101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)