Provider Demographics
NPI:1548695992
Name:KENNEDY, WANDERLY CASALI (BA, CPRP)
Entity type:Individual
Prefix:MRS
First Name:WANDERLY
Middle Name:CASALI
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:BA, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-4763
Mailing Address - Country:US
Mailing Address - Phone:727-804-2280
Mailing Address - Fax:
Practice Address - Street 1:647 34TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3730
Practice Address - Country:US
Practice Address - Phone:727-824-5745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health