Provider Demographics
NPI:1548718356
Name:KENNEY, STEPHANIE J (LCMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:KENNEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:INTERVALE
Mailing Address - State:NH
Mailing Address - Zip Code:03845-0353
Mailing Address - Country:US
Mailing Address - Phone:908-922-7506
Mailing Address - Fax:
Practice Address - Street 1:2977 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5111
Practice Address - Country:US
Practice Address - Phone:603-651-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5084101YP2500X
NJ37PC00525100101YP2500X
NJ590738101YS0200X
NH2089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool