Provider Demographics
NPI:1972285252
Name:KOLENIK, KENDALL (LMSW)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:KOLENIK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 78TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6770
Mailing Address - Country:US
Mailing Address - Phone:475-298-7902
Mailing Address - Fax:
Practice Address - Street 1:145 W 78TH ST APT 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6770
Practice Address - Country:US
Practice Address - Phone:475-298-7902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL069792001041C0700X
NY1200171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical