Provider Demographics
NPI:1235922923
Name:KENNEDY, PATRICK (MSSW)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 MANOR RD UNIT 202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-0003
Mailing Address - Country:US
Mailing Address - Phone:210-240-0611
Mailing Address - Fax:
Practice Address - Street 1:4110 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4223
Practice Address - Country:US
Practice Address - Phone:512-491-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program