Provider Demographics
NPI:1326374224
Name:KENDALL, LISA ANNE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 DRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-9613
Mailing Address - Country:US
Mailing Address - Phone:607-351-1313
Mailing Address - Fax:
Practice Address - Street 1:401 EAST STATE STREET
Practice Address - Street 2:SUITE 400, OFFICE #1
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4229
Practice Address - Country:US
Practice Address - Phone:607-351-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR071592-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical