Michael Shawn Kennedy, SCHOOL PSYCHOLOGIST
Individual provider Active NPI School Psychologist · Dulce, NM
NPI 1306116066 · NPPES record last updated Jan 11, 2012
Key facts
- NPI
- 1306116066
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- License
- 344005 (NM)
- Practice address
- 113 Hawk Dr
Dulce, NM 87528 - Phone
- (575) 759-3225
- Fax
- (575) 759-3533
- NPI assigned
- Jan 11, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 344005 | NM | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dulce Independent School District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 344005 | NM | Yes |
Addresses
Primary practice location
113 Hawk Dr
Dulce, NM 87528
Mailing address
113 Hawks Dr
Dulce, NM 87528
Phone (575) 759-3225
Other providers in Dulce, NM
- Jicarilla Health Care Facility
- Jicarilla IHS Pharmacy
- Ray Morris Joe
- Joan E Kandel
- Karen Keating
- Valerie F Long
- Daniel Joseph Lotz
- Jenna Lotz
- Marie S March
- Richard Allen March
All providers in Dulce, NM · School Psychologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.