Active NPI
Susan Emily Kennedy
- Behavior Analyst
- Lakeland, FL
National Provider Identifier
1659858686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- RBT-16-16370
- Practice address
- 304 E Pine St # 19
Lakeland, FL 33801-4969 - Phone
- (863) 614-0048
- Fax
- (863) 279-1204
- NPI assigned
- Jul 23, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | RBT-16-16370 | FL | Primary |
Addresses
Primary practice location
304 E Pine St # 19
Lakeland, FL 33801-4969
Mailing address
304 E Pine St # 19
Lakeland, FL 33801-4969
Phone (863) 614-0048
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 023072500 | Medicaid | FL |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-16-16370 | FL | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532304000000",
"number": "1659858686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 E PINE ST # 19",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338014969",
"telephone_number": "863-614-0048",
"fax_number": "863-279-1204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 E PINE ST # 19",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338014969",
"telephone_number": "863-614-0048",
"fax_number": "863-279-1204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "SUSAN",
"middle_name": "EMILY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-23",
"last_updated": "2018-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "FL",
"license": "RBT-16-16370",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "023072500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.