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KENNEDY MEDICAL GROUP PRACTICE P.C. NPI 1497295109


NPI Information

NPI: 1497295109
Provider Name: KENNEDY MEDICAL GROUP PRACTICE P.C.

Doing Business As: KENNEDY HEALTH ALLIANCE

Classification: Psychologist - 103TP0016X
Entity Type: Organization

Specialization: Prescribing (Medical)

Address:
900 ROUTE 168
SUITE C#3
BLACKWOOD, NJ
ZIP 08012
Phone: (856) 857-6920
Get Directions

KENNEDY MEDICAL GROUP PRACTICE P.C. is a prescribing (medical) psychologist in Blackwood, NJ. The provider is a licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended. KENNEDY MEDICAL GROUP PRACTICE P.C. NPI is 1497295109. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Kennedy Health Alliance.

The provider's business location address is:

900 ROUTE 168
SUITE C#3
BLACKWOOD, NJ
ZIP 08012-233
Phone: (856) 857-6920

The provider's authorized official is Carman A Ciervo .
The authorized official title is Cpe and has the following contact phone number (856) 344-7360.

The enumeration date for this NPI number is 2/28/2017 and was last updated on 2/28/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103T00000XPsychologistNo
2103TA0400XPsychologistAddiction (Substance Use Disorder)No
3103TP0016XPsychologistPrescribing (Medical)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10411248MEDICAIDNEW JERSEY
2348438MEDICARE PINNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.