Provider Demographics
NPI:1578762225
Name:KENDER, ROBERT G (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:KENDER
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 1:415 S MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2079
Mailing Address - Country:US
Mailing Address - Phone:313-269-7718
Mailing Address - Fax:
Practice Address - Street 1:415 S MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2079
Practice Address - Country:US
Practice Address - Phone:313-269-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015273103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist