Provider Demographics
NPI:1457131120
Name:KENDRICK, MELISSA BERTINA (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BERTINA
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KENDRICK
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CLINICAL SOCIAL WORK
Mailing Address - Street 1:117 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-5400
Mailing Address - Country:US
Mailing Address - Phone:401-444-3734
Mailing Address - Fax:
Practice Address - Street 1:117 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-5400
Practice Address - Country:US
Practice Address - Phone:401-444-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW02765104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty