1255665030 NPI number — MR. BRIAN ERIC KENNEDY-ARENIVAR LMHC, LPC-S

Table of content: MR. BRIAN ERIC KENNEDY-ARENIVAR LMHC, LPC-S (NPI 1255665030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255665030 NPI number — MR. BRIAN ERIC KENNEDY-ARENIVAR LMHC, LPC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEDY-ARENIVAR
Provider First Name:
BRIAN
Provider Middle Name:
ERIC
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, LPC-S
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENNEDY
Provider Other First Name:
BRIAN
Provider Other Middle Name:
ERIC
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC-S, LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255665030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 E 23RD ST STE 402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10010-4547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-590-1211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 E 23RD ST STE 402
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-4547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-984-8600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 011500 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 63604 . This is a "STATE BOARD LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 011500 . This is a "STATE BOARD LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".