Provider Demographics
NPI:1811532773
Name:HOLT, KENDRA MORRIS (LCSW)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:MORRIS
Last Name:HOLT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 52ND DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-3724
Mailing Address - Country:US
Mailing Address - Phone:850-319-7744
Mailing Address - Fax:
Practice Address - Street 1:8730 52ND DR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-3724
Practice Address - Country:US
Practice Address - Phone:850-319-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW66951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical