Provider Demographics
NPI:1770133555
Name:SENDROWITZ O'CONNOR, KERRIN (PHD)
Entity type:Individual
Prefix:
First Name:KERRIN
Middle Name:
Last Name:SENDROWITZ O'CONNOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KERRIN
Other - Middle Name:
Other - Last Name:SENDROWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1509 S OUTAGAMIE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5580
Mailing Address - Country:US
Mailing Address - Phone:518-698-3103
Mailing Address - Fax:
Practice Address - Street 1:1509 S OUTAGAMIE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5580
Practice Address - Country:US
Practice Address - Phone:518-698-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020475103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020475OtherPSYCHOLOGY LICENSE