Provider Demographics
NPI:1851169858
Name:KENDALL, JULIA CORINNE (MSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:CORINNE
Last Name:KENDALL
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 1:3855 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MIMS
Mailing Address - State:FL
Mailing Address - Zip Code:32754-4778
Mailing Address - Country:US
Mailing Address - Phone:321-514-3288
Mailing Address - Fax:
Practice Address - Street 1:1301 BEDFORD DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1809
Practice Address - Country:US
Practice Address - Phone:321-514-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW198111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical