Provider Demographics
NPI:1497166631
Name:KENDUS, NICHOLAS (MA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:KENDUS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3010
Mailing Address - Country:US
Mailing Address - Phone:717-560-7917
Mailing Address - Fax:717-208-7105
Practice Address - Street 1:390 WATERLOO BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2603
Practice Address - Country:US
Practice Address - Phone:610-363-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1053341859Medicaid