Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Mary Theresa Kennedy, PHD

Individual provider Clinical Psychologist · NPI 1861479636

Dr. Mary Theresa Kennedy, PHD is a Clinical Psychologist in Bayside, New York. Qualified in 1971, 55 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
55
Licensed in
NY
In the registry since
2005
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

217-04 Northern Blvd Ste 16
Bayside, NY 11361-3500
Phone: (718) 631-8939
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 00760201 (NY)

Record details

NPI number1861479636
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHD
Sole proprietorYes
NPI enumeratedDecember 22, 2005
Last updated in NPPESSeptember 3, 2010

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 1971 (55 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Bayside