Kennedy Health System

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

KENNEDY HEALTH SYSTEM

Practice address

454 Hurffville Crosskeys Rd
Sewell, NJ 08080-2339

Phone

(856) 582-1419

Fax

(856) 582-7661

NPI assigned

May 21, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Russ Micoli, MA, MHA

Title

Corp. Director, Behavioral Health

Phone

(856) 488-6701

Specialties & licenses 2

Addresses

Tax ID family

Kennedy Health System2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Kennedy Health System

  • Psychiatric Hospital
  • Sewell, NJ
  • NPI 1730444225
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274400000000",
    "number": "1033438643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 CHAPEL AVE W",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080022048",
            "telephone_number": "856-488-6500",
            "fax_number": "856-488-6415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 HURFFVILLE CROSSKEYS RD",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802339",
            "telephone_number": "856-582-1419",
            "fax_number": "856-582-7661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-21",
        "last_updated": "2010-05-21",
        "status": "A",
        "authorized_official_last_name": "MICOLI",
        "authorized_official_first_name": "RUSS",
        "authorized_official_title_or_position": "CORP. DIRECTOR, BEHAVIORAL HEALTH",
        "authorized_official_telephone_number": "856-488-6701",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, MHA"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Kearney, DPT
• Michael K Keene Sr., D.MIN
• Ashley Kendra, FNP-C
• Kennedy Behavorial Health
• Kennedy Health Facilities, Inc.
• Kennedy Health System
• Kennedy Health System
• Kennedy Health Systems
• Kennedy Medical Group Practice P.C.
• Kennedy Medical Group Practice P.C. D/B/a Kennedy Health Alliance

• Adolescent and Children Mental Health Clinic/Center in Sewell, NJ
• Providers in Sewell, NJ by specialty
• Adolescent and Children Mental Health Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.