Provider Demographics
NPI:1033658471
Name:COKER, KENDELL LAMONTE (PHD, JD)
Entity Type:Individual
Prefix:DR
First Name:KENDELL
Middle Name:LAMONTE
Last Name:COKER
Suffix:
Gender:M
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 MILL ST BLDG B
Mailing Address - Street 2:STRAUN HEALTH AND WELLNESS
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023-1159
Mailing Address - Country:US
Mailing Address - Phone:860-756-0455
Mailing Address - Fax:
Practice Address - Street 1:1224 MILL ST BLDG B
Practice Address - Street 2:STRAUN HEALTH AND WELLNESS
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1159
Practice Address - Country:US
Practice Address - Phone:860-756-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3203103T00000X
IL071007774103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist