Provider Demographics
NPI:1003705500
Name:KENNEDY, MARISSA LENORE (BCBA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LENORE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 N LOGAN ST UNIT 726
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2160
Mailing Address - Country:US
Mailing Address - Phone:303-335-7963
Mailing Address - Fax:
Practice Address - Street 1:1401 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-5715
Practice Address - Country:US
Practice Address - Phone:720-704-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst