Provider Demographics
NPI:1447876875
Name:KENNEDY, BENJAMIN DUNCAN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DUNCAN
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15055 QUITO RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6296
Mailing Address - Country:US
Mailing Address - Phone:408-406-2522
Mailing Address - Fax:
Practice Address - Street 1:100 OCONNOR DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1647
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician