Basic Information
| Provider Information | |||||||||
| NPI: | 1730444225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENNEDY HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 454 HURFFVILLE CROSSKEYS RD | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080802339 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 454 HURFFVILLE CROSSKEYS RD | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080802339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565821419 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2012 | ||||||||
| LastUpdateDate: | 07/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | KAPLAN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MASTERS LEVEL CLINICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8565821419 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.