Provider Demographics
NPI:1457832776
Name:KENDERISH, KARA (PSYD)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:KENDERISH
Suffix:
Gender:F
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:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13795-0391
Mailing Address - Country:US
Mailing Address - Phone:607-600-2603
Mailing Address - Fax:
Practice Address - Street 1:28 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795-1428
Practice Address - Country:US
Practice Address - Phone:607-600-2603
Practice Address - Fax:607-214-2400
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical