Provider Demographics
NPI:1790040830
Name:ANDERSON, KENDRA SUSAN (MSW)
Entity Type:Individual
Prefix:MISS
First Name:KENDRA
Middle Name:SUSAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S MIAMI AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1617
Mailing Address - Country:US
Mailing Address - Phone:305-374-6006
Mailing Address - Fax:
Practice Address - Street 1:155 S MIAMI AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1617
Practice Address - Country:US
Practice Address - Phone:305-374-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical