Basic Information
| Provider Information | |||||||||
| NPI: | 1376164269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | ROXANA | ||||||||
| MiddleName: | SHOHREH | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 ELSINORE PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452021457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8335104357 | ||||||||
| FaxNumber: | 8664602997 | ||||||||
| Practice Location | |||||||||
| Address1: | 4135 DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | ELSMERE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410181815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8335104357 | ||||||||
| FaxNumber: | 8664602997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2020 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S.2106606 | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | 246171 | KY | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 104100000X | 256021 | KY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.