Active NPI
Amy Dexter Kennicutt, PSY.D.
- Psychologist
- Littleton, CO
National Provider Identifier
1407184401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 5753 S Prince St
Littleton, CO 80120-1927 - Phone
- (970) 368-5552
- NPI assigned
- Dec 2, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4953 | CO | |
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
5753 S Prince St
Littleton, CO 80120-1927
Mailing address
PO Box 1172
Littleton, CO 80160-1172
Phone (970) 368-5552
Other practice location 1
3020 Carbon Pl
Boulder, CO 80301-6169
Phone (970) 368-5552
Other practice location 2
4956 S Prince Ct Apt 304
Littleton, CO 80123-7792
Phone (970) 368-5552
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Nov 19, 2015 through Nov 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4953 | CO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607904000000",
"number": "1407184401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1172",
"city": "LITTLETON",
"state": "CO",
"postal_code": "801601172",
"telephone_number": "970-368-5552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5753 S PRINCE ST",
"city": "LITTLETON",
"state": "CO",
"postal_code": "801201927",
"telephone_number": "970-368-5552"
}
],
"practiceLocations": [
{
"address_1": "3020 Carbon Pl",
"address_purpose": "LOCATION",
"city": "Boulder",
"state": "CO",
"postal_code": "803016169",
"country_code": "US",
"telephone_number": "970-368-5552",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4956 S Prince Ct Apt 304",
"address_purpose": "LOCATION",
"city": "Littleton",
"state": "CO",
"postal_code": "801237792",
"country_code": "US",
"telephone_number": "970-368-5552",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DEXTER KENNICUTT",
"first_name": "AMY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-02",
"last_updated": "2020-12-14",
"certification_date": "2020-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "4953",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Littleton, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.