Provider Demographics
NPI:1558959775
Name:STINSON, KENDRA LEEANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:LEEANN
Last Name:STINSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3814
Mailing Address - Country:US
Mailing Address - Phone:781-937-8233
Mailing Address - Fax:
Practice Address - Street 1:55 LOCUST ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3814
Practice Address - Country:US
Practice Address - Phone:781-937-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1141451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA114145OtherDIVISION OF PROFESSIONAL LICENSURE BOARD OF SOCIAL WORKERS