Provider Demographics
NPI:1720468572
Name:KENDRICK, LORI (MA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1605
Mailing Address - Country:US
Mailing Address - Phone:440-988-4406
Mailing Address - Fax:
Practice Address - Street 1:185 FOREST ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1605
Practice Address - Country:US
Practice Address - Phone:440-988-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP390103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool