Provider Demographics
NPI:1740928506
Name:KENDALL, JASMAIN ALIETA (LPC)
Entity type:Individual
Prefix:
First Name:JASMAIN
Middle Name:ALIETA
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 ELM COMMONS DR APT 303
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1816
Mailing Address - Country:US
Mailing Address - Phone:610-653-6663
Mailing Address - Fax:
Practice Address - Street 1:967 ELM COMMONS DR APT 303
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1816
Practice Address - Country:US
Practice Address - Phone:484-378-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional