Provider Demographics
NPI:1790272110
Name:KENDZEJESKI, RACHEL LYNN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:KENDZEJESKI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:HALLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3823 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1414
Mailing Address - Country:US
Mailing Address - Phone:410-688-3775
Mailing Address - Fax:
Practice Address - Street 1:1714 JARRETTSVILLE RD
Practice Address - Street 2:
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084
Practice Address - Country:US
Practice Address - Phone:443-613-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD162751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty