Dr Lara Danielle Kennerly, PSYD is a
Psychologist based in Represa, California. Dr Lara Danielle Kennerly is licensed to practice in California (license number PSY29433) and her current practice location is
100 Prison Rd, Represa, California. She can be reached at her office (for appointments etc.) via phone at
(858) 229-3219.
NPI number for Dr Lara Danielle Kennerly is 1912074329 and her current mailing address is 100 Prison Rd, Represa, California. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1912074329.
Healthcare Provider's Profile
| Full Name | Dr Lara Danielle Kennerly |
|---|
| Gender | Female |
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| Speciality | Psychologist |
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| Location | 100 Prison Rd, Represa, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1912074329
- Provider Enumeration Date: 11/29/2006
- Last Update Date: 08/23/2022
Medical Identifiers
Medical identifiers for Dr Lara Danielle Kennerly such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1912074329 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | PSY29433 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Lara Danielle Kennerly is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Lara Danielle Kennerly, PSYD
100 Prison Rd,
Represa, CA 95671-3000
Ph: (858) 229-3219 | Dr Lara Danielle Kennerly, PSYD
100 Prison Rd,
Represa, CA 95671-3000
Ph: (858) 229-3219 |
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