Provider Demographics
NPI:1760279947
Name:KENNEDY, DANIEL E (DSW, AMFT, MSC, MBA)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:KENNEDY
Suffix:
Gender:
Credentials:DSW, AMFT, MSC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9120 JUDICIAL DR UNIT 7124
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-6702
Mailing Address - Country:US
Mailing Address - Phone:619-300-2625
Mailing Address - Fax:
Practice Address - Street 1:9120 JUDICIAL DR UNIT 7124
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-6702
Practice Address - Country:US
Practice Address - Phone:619-300-2625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT151485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist