Provider Demographics
NPI:1922994730
Name:KENNEDY, KYRSTEN (MA)
Entity type:Individual
Prefix:
First Name:KYRSTEN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-4340
Mailing Address - Country:US
Mailing Address - Phone:267-574-5977
Mailing Address - Fax:
Practice Address - Street 1:2003 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-4340
Practice Address - Country:US
Practice Address - Phone:267-574-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health