Provider Demographics
NPI:1649583147
Name:KENDALL, CARMEN (LCSW)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E 7TH AVE
Mailing Address - Street 2:SUITE 220-A
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2773
Mailing Address - Country:US
Mailing Address - Phone:541-242-0455
Mailing Address - Fax:
Practice Address - Street 1:211 E 7TH AVE
Practice Address - Street 2:SUITE 220-A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2773
Practice Address - Country:US
Practice Address - Phone:541-242-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORA037881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health