Provider Demographics
NPI:1306866942
Name:GENDRON, KAY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:LYNN
Last Name:GENDRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1903
Mailing Address - Country:US
Mailing Address - Phone:570-253-2171
Mailing Address - Fax:570-253-7788
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1903
Practice Address - Country:US
Practice Address - Phone:570-253-2171
Practice Address - Fax:570-253-7788
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004675L103T00000X
MNLP3065103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGE039715Medicare ID - Type Unspecified