Provider Demographics
NPI:1366831315
Name:KLAS, KENDALL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:
Last Name:KLAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KENDALL
Other - Middle Name:
Other - Last Name:STAGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2135
Mailing Address - Country:US
Mailing Address - Phone:908-725-2800
Mailing Address - Fax:908-704-1790
Practice Address - Street 1:500 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2135
Practice Address - Country:US
Practice Address - Phone:908-725-2800
Practice Address - Fax:908-704-1790
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056526001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527486OtherAGENCY MEDICARE PROVIDER NUMBER
NJ0023701OtherAGENCY MEDICAID PROVIDER NUMBER