Jack Timothy Kennedy, M.A. LICDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

991698 Issued in OH

Practice address

8833 Chapelsquare LN
Cincinnati, OH 45249-4705

Phone

(513) 774-9444

Fax

(513) 774-9888

NPI assigned

Dec 27, 2006

Sex

Male

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)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Individual Care Center

  • Community/Behavioral Health Agency
  • Cincinnati, OH
  • NPI 1114105244
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861557829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8833 CHAPELSQUARE LN",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452494705",
            "telephone_number": "513-774-9444",
            "fax_number": "513-774-9888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8833 CHAPELSQUARE LN",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452494705",
            "telephone_number": "513-774-9444",
            "fax_number": "513-774-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JACK",
        "middle_name": "TIMOTHY",
        "name_prefix": "Mr.",
        "credential": "M.A. LICDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "991698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allyson Kennedy, LSW
• Amaya Carmen Kennedy
• Deirdre Ann Kennedy, NURSE AID
• Erin Kennedy, PH.D.
• Erin E Kennedy, CNP
• Jamie Renee Kennedy, RN
• Jasmine J Kennedy
• Jeffrey G Kennedy, MA, LPCC, CDCA
• Jessica A Kennedy
• John Kennedy III, MD

• Addiction (Substance Use Disorder) Counselor in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.