Provider Demographics
NPI:1639996051
Name:BEVERIDGE, KENDRA MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:MARIE
Last Name:BEVERIDGE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LAKE SARGENT DR
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-1927
Mailing Address - Country:US
Mailing Address - Phone:774-239-3844
Mailing Address - Fax:
Practice Address - Street 1:29 LAKE SARGENT DR
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1927
Practice Address - Country:US
Practice Address - Phone:774-239-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health