Active NPI
Theresa Wagner Kennedy, LCSW
- Psychologist
- Oakhurst, CA
National Provider Identifier
1952431678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LCS10602
- Practice address
- 40459 Hwy 41
Ste 5
Oakhurst, CA 93644 - Phone
- (559) 683-3657
- Fax
- (559) 642-0673
- NPI assigned
- Mar 6, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LCS10602 | CA | Primary |
Addresses
Primary practice location
40459 Hwy 41
Ste 5
Oakhurst, CA 93644
Mailing address
PO Box 1667
Oakhurst, CA 93644
Phone (559) 683-3657
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 |
|---|---|---|---|
| LCS10602 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1952431678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1667",
"city": "OAKHURST",
"state": "CA",
"postal_code": "93644",
"telephone_number": "559-683-3657",
"fax_number": "559-642-0673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40459 HWY 41",
"address_2": "STE 5",
"city": "OAKHURST",
"state": "CA",
"postal_code": "93644",
"telephone_number": "559-683-3657",
"fax_number": "559-642-0673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "THERESA",
"middle_name": "WAGNER",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "LCS10602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakhurst, CA
Sources for this page
- 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.