Provider Demographics
NPI:1285189977
Name:KENDALL, BRIAN (LMSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KENDALL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14935 OVERBROOK DR APT 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2238
Mailing Address - Country:US
Mailing Address - Phone:586-945-7869
Mailing Address - Fax:
Practice Address - Street 1:4777 E OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3241
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:313-576-1570
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010982841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical