Provider Demographics
NPI:1780562256
Name:SMALL, KENDALL LAYNE (LAC)
Entity type:Individual
Prefix:MISS
First Name:KENDALL
Middle Name:LAYNE
Last Name:SMALL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1333
Mailing Address - Country:US
Mailing Address - Phone:732-768-6108
Mailing Address - Fax:
Practice Address - Street 1:78 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760-1333
Practice Address - Country:US
Practice Address - Phone:732-768-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health