DR. MARY LYNNE KENNEDY (NPI# 1376619239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376619239 |
| Entity Type | Individual |
| Full Name | DR. MARY LYNNE KENNEDY |
| Practice Address |
21 Peace St Providence RI 02907-1510 |
| Mailing Address |
200 High Service Ave North Providence RI 02904-5113 |
| Practice Telephone | 4014563309 |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2007-09-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | PS00572 | RI | Behavioral Health & Social Service Providers |
| N | 103T00000X | Psychologist | PS00572 | RI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | LICENSE NUMBER | PS00572 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336418169 | Mary Katherine Kennedy | Developmental Therapist | 10727 Burr Oak Way, Burke, VA 22015-2414 | 2011-12-22 |
| 1568635738 | Mary A Kennedy | Speech-Language Pathologist | 1801 Alfresco Pl, Louisville, KY 40205-1807 | 2008-04-09 |
| 1518095660 | Mary S. Kennedy | Social Worker | 16 Fayette St, Cambridge, MA 02139-1112 | 2007-03-01 |
| 1053455568 | Mary Kathleen Kennedy | Speech-Language Pathologist | 1613 Ginger Dr, Hideaway, TX 75771-5311 | 2007-02-16 |
| 1578656716 | Mary Kennedy | Nurse Practitioner | 105 E Hack St, Cullom, IL 60929 | 2006-10-02 |
| 1093821894 | Mary Kathryn Kennedy | Nurse Anesthetist, Certified Registered | 1845 S Fm 51 Unit A-2, Decatur, TX 76234-3764 | 2006-08-22 |
| 1992750517 | Mary Kay Kennedy | Social Worker | 363 South Harlan Street, Suite 200, Denver, CO 80226-3552 | 2006-05-23 |
| 1972563757 | Mary M Kennedy | Social Worker | 181 W Professional Park Ct, Suite 1, Bowling Green, KY 42104-3250 | 2006-03-24 |
| 1861479636 | Mary Theresa Kennedy | Psychologist | 217-04 Northern Blvd, Ste 16, Bayside, NY 11361-3500 | 2005-12-22 |
| 1518471226 | Mary Kennedy | Counselor | 1010 Remington Plz, Raymore, MO 64083-8640 | 2017-11-17 |
| Street Address |
21 PEACE ST |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02907-1510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033103098 | Stanley John Stutz Jr. | Orthopaedic Surgery | 21 Peace St, Corporate Care, Providence, RI 02907-1510 | 2005-09-07 |
| 1083249098 | Anna Lam | Student in an Organized Health Care Education/Training Program | 21 Peace St, Providence, RI 02907-1510 | 2020-03-10 |
| 1447884861 | Adam Takeo Ellenthal | Student in an Organized Health Care Education/Training Program | 21 Peace St, Providence, RI 02907-1510 | 2020-02-25 |
| 1275166050 | Christopher Padhi | Student in an Organized Health Care Education/Training Program | 21 Peace St, Providence, RI 02907-1510 | 2020-02-19 |
| 1770040412 | Tyler Anthony Beninati | Student in an Organized Health Care Education/Training Program | 21 Peace St, Providence, RI 02907-1510 | 2019-03-01 |
| 1972060606 | Gabrielle Morgan Lieberman | Student in an Organized Health Care Education/Training Program | 21 Peace St, Providence, RI 02907-1510 | 2019-02-28 |
| 1962969691 | John Anthony Power IIi | Student in an Organized Health Care Education/Training Program | 21 Peace St, Providence, RI 02907-1510 | 2019-02-28 |
| 1386101541 | Victoria Anne Gill | Student in an Organized Health Care Education/Training Program | 21 Peace St, Providence, RI 02907-1510 | 2019-02-25 |
| 1740772037 | Tiffany Diem Tu Ngo | Student in an Organized Health Care Education/Training Program | 21 Peace St, Providence, RI 02907-1510 | 2018-06-01 |
| 1841794500 | Amrita Khemka | Student in an Organized Health Care Education/Training Program | 21 Peace St, Providence, RI 02907-1510 | 2018-03-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518522861 | Catherine M Katzberg | Massage Therapist | Santosha Yoga Studio, 275 Reservoir Ave, Providence, RI 02907 | 2019-05-02 |
| 1104317007 | Victa LLC | Internal Medicine | 110 Elmwood Ave # A, Providence, RI 02907 | 2018-05-25 |
| 1639566987 | Southside Elementary Charter School | Local Education Agency (LEA) | 126 Somerset Street, Providence, RI 02907 | 2015-04-23 |
| 1063846558 | Achievement First Providence Mayoral Academy Charter School | Local Education Agency (LEA) | 370 Hartford Aveneue, Providence, RI 02907 | 2013-09-03 |
| 1912297425 | Reynaldo P Baduya Sr.,dmd | Clinic/Center | 252 Adelaide Avenue, Providence, RI 02907 | 2011-04-18 |
| 1821218587 | Map Behavioral Health Serv. Inc. | Community/Behavioral Health | 66 Burnett Street, Providence, RI 02907 | 2007-04-26 |
| 1548336944 | Angelica Redleaf | Chiropractor | 1196 Elmwood Avenue, Providence, RI 02907 | 2006-11-28 |
| 1174619878 | Emilio Rodriguez-peris | Internal Medicine | 655 Broad Street, Suite 201, Providence, RI 02907 | 2006-10-04 |
| 1841381555 | Maged Taman | Internal Medicine | 21 Peace Street, Providence, RI 02907 | 2006-09-27 |
| 1003924226 | Gladys V Rezendes | Psychologist | 118 Comstock Avenue, Providence, RI 02907 | 2006-08-28 |
| Find all providers in zip 02907 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689299661 | Laura Elizabeth Korthauer Gilmour | Clinical Neuropsychologist | 110 Lockwood St Ste 430, Providence, RI 02903-4815 | 2020-06-15 |
| 1992339501 | Carmen G Armengol | Clinical Neuropsychologist | 58 Rochambeau Ave, Providence, RI 02906-1908 | 2020-02-24 |
| 1356833024 | Natalie Rita Noonan | Clinical Neuropsychologist | 593 Eddy St Ste 430, Providence, RI 02903 | 2018-05-30 |
| 1902329667 | Neuroperformance Group, L.l.c | Clinical Neuropsychologist | Two Regency Plaza, Suite 3, Providence, RI 02903 | 2017-07-24 |
| 1871856484 | Rachel K Baldwin | Clinical Neuropsychologist | 355 Hope Street, 2nd Floor, Unit 6, Providence, RI 02906 | 2012-06-19 |
| 1932338951 | Melissa Perkins-banas | Clinical Neuropsychologist | 260 W Exchange St Ste 210, Providence, RI 02903-1000 | 2009-07-12 |
| 1578570735 | Steven J. Hirsch | Clinical Neuropsychologist | 1 Richmond Sq Ste 104c, Providence, RI 02906-5154 | 2006-08-01 |
| 1508485301 | Brian Charles Castelluccio | Clinical Neuropsychologist | 345 Blackstone Blvd, Providence, RI 02906-4800 | 2020-04-11 |
| 1770130692 | Louisa Isoud Thompson | Clinical Neuropsychologist | 345 Blackstone Blvd Ste 2, Providence, RI 02906-4829 | 2019-08-26 |
| 1336608843 | Sarah Catherine Pillemer | Clinical Neuropsychologist | 146 W River St Ste 11a, Providence, RI 02904-2609 | 2019-03-14 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02907 |
Please comment or provide details below to improve the information on DR. MARY LYNNE KENNEDY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.