Provider Demographics
NPI:1528378304
Name:KENDALL, WALTER A (PHD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:A
Last Name:KENDALL
Suffix:
Gender:M
Credentials:PHD
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 778
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413-0778
Mailing Address - Country:US
Mailing Address - Phone:518-719-8873
Mailing Address - Fax:518-719-8873
Practice Address - Street 1:12 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-2850
Practice Address - Country:US
Practice Address - Phone:518-622-9163
Practice Address - Fax:518-622-8592
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019109103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist