Catherine Reese Kennedy, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

C40320 Issued in CA

Practice address

161 Mitchell Blvd
San Rafael, CA 94903-2068

Phone

(415) 499-6777

Fax

(415) 499-3080

NPI assigned

Feb 22, 2007

Last updated

Dec 27, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324944000000",
    "number": "1194850958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3230 KERNER BLVD",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949014840",
            "telephone_number": "415-499-6777",
            "fax_number": "415-499-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 MITCHELL BLVD",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032068",
            "telephone_number": "415-499-6777",
            "fax_number": "415-499-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CATHERINE",
        "middle_name": "REESE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2011-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "C40320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carmalita Marshall Kemayo
• Michelle Rae Kemp, CERTIFIED PEER
• Maryann Kemper, MFT
• Judith Lynne Kendall, M.A., MFT
• Page Kennedy Bettencourt, OTR/L
• Derrick Kennedy
• Winnifred A Kennedy
• Aaron Ray Kenney, MFT INTERN
• Shana Gaviglio Kenney
• Kristina Nadine Kenny, DPT

• Child & Adolescent Psychiatry Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Child & Adolescent Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; 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.