Provider Demographics
NPI:1114958063
Name:TRUFAHNESTOCK, KENDRA ALAYNE (LSW)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:ALAYNE
Last Name:TRUFAHNESTOCK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:ALAYNE
Other - Last Name:FAHNESTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3012 LOCUST LANE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-3535
Mailing Address - Country:US
Mailing Address - Phone:717-545-3996
Mailing Address - Fax:
Practice Address - Street 1:3235 NORTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1308
Practice Address - Country:US
Practice Address - Phone:717-234-3839
Practice Address - Fax:717-234-6247
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1237441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical