Provider Demographics
NPI:1205134632
Name:KENNEDY, JODI MICHELE
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:MICHELE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2941
Mailing Address - Country:US
Mailing Address - Phone:718-779-1600
Mailing Address - Fax:718-803-0895
Practice Address - Street 1:37-22 82ND ST.
Practice Address - Street 2:CORONA ELMHURST GUIDANCE CENTER
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11732
Practice Address - Country:US
Practice Address - Phone:718-779-1600
Practice Address - Fax:718-803-0895
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical