Basic Information
| Provider Information | |||||||||
| NPI: | 1033140256 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | HILL | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 PEBBLEBROOK LN APT 308 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229027172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349248024 | ||||||||
| FaxNumber: | 4342436546 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 HOVEY RD | ||||||||
| Address2: | NAVAL OPERATIONAL MEDICINE INSTITUTE | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325081044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504522257 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 3757 | MD | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | VA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.