Provider Demographics
NPI:1245269968
Name:KENDALL, ANNA ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:ELIZABETH
Last Name:KENDALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 WASHINGTON BLVD
Mailing Address - Street 2:#305
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5421
Mailing Address - Country:US
Mailing Address - Phone:310-822-4238
Mailing Address - Fax:310-306-3231
Practice Address - Street 1:14002 PALAWAN WAY
Practice Address - Street 2:#215
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6258
Practice Address - Country:US
Practice Address - Phone:310-822-4238
Practice Address - Fax:310-306-3231
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19739103G00000X, 103TA0700X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP19739Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST