Provider Demographics
NPI:1346654019
Name:ENDO, TAKANORI KENNETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAKANORI
Middle Name:KENNETH
Last Name:ENDO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CRESTWOOD CT S
Mailing Address - Street 2:#1318
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4924
Mailing Address - Country:US
Mailing Address - Phone:305-490-1498
Mailing Address - Fax:
Practice Address - Street 1:1300 CRESTWOOD CT S
Practice Address - Street 2:#1318
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4924
Practice Address - Country:US
Practice Address - Phone:305-490-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor