Active NPI
Martin Gerard Kennedy, PH.D.
- Counseling Psychologist
- O Fallon, MO
National Provider Identifier
1477846087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 2011011884
- Practice address
- 4142 Keaton Crossing Blvd
Suite 101
O Fallon, MO 63368-8404 - Phone
- (636) 300-9333
- NPI assigned
- May 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 2011011884 | MO | Primary |
Addresses
Primary practice location
4142 Keaton Crossing Blvd
Suite 101
O Fallon, MO 63368-8404
Mailing address
4142 Keaton Crossing Blvd
Suite 101
O Fallon, MO 63368-8404
Phone (636) 300-9333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011011884 | MO | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305504000000",
"number": "1477846087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4142 KEATON CROSSING BLVD",
"address_2": "SUITE 101",
"city": "O FALLON",
"state": "MO",
"postal_code": "633688404",
"telephone_number": "636-300-9333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4142 KEATON CROSSING BLVD",
"address_2": "SUITE 101",
"city": "O FALLON",
"state": "MO",
"postal_code": "633688404",
"telephone_number": "636-300-9333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MARTIN",
"middle_name": "GERARD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-16",
"last_updated": "2011-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MO",
"license": "2011011884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.