Provider Demographics
NPI:1235675752
Name:KENNEDY, DANIELLE ELISABETH (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELISABETH
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MAPLE AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1535
Mailing Address - Country:US
Mailing Address - Phone:860-946-0362
Mailing Address - Fax:
Practice Address - Street 1:56 MAPLE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1535
Practice Address - Country:US
Practice Address - Phone:860-946-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-16-24172103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst