Provider Demographics
NPI:1588992481
Name:HENNESSEY, MAUREEN THERESA (PHD, CPCC)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:THERESA
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:PHD, CPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 W 62ND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2910
Mailing Address - Country:US
Mailing Address - Phone:816-363-4220
Mailing Address - Fax:816-363-4220
Practice Address - Street 1:1229 W 62ND ST APT 1
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2910
Practice Address - Country:US
Practice Address - Phone:816-363-4220
Practice Address - Fax:816-363-4220
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01014103TC0700X
IL071.004619103TC0700X
KS1031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical