Provider Demographics
NPI:1376641589
Name:KENDALL, BARRY RAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:RAY
Last Name:KENDALL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:520 S SEPULVEDA BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3534
Mailing Address - Country:US
Mailing Address - Phone:310-738-4523
Mailing Address - Fax:310-738-4523
Practice Address - Street 1:520 S SEPULVEDA BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3534
Practice Address - Country:US
Practice Address - Phone:310-738-4523
Practice Address - Fax:424-226-1770
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17747103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY177470Medicaid