Provider Demographics
NPI:1295361483
Name:KENDALL, STEPHEN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:KENDALL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 29TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2578
Mailing Address - Country:US
Mailing Address - Phone:917-202-2586
Mailing Address - Fax:
Practice Address - Street 1:2038 29TH ST APT 2
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2578
Practice Address - Country:US
Practice Address - Phone:917-202-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health