Provider Demographics
NPI:1487077160
Name:KENNELL, CASSANDRA (PHD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:KENNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 KENMORE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4338
Mailing Address - Country:US
Mailing Address - Phone:540-251-7728
Mailing Address - Fax:
Practice Address - Street 1:58 KENMORE ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4338
Practice Address - Country:US
Practice Address - Phone:540-251-7728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA14205002000422Medicare PIN