Provider Demographics
NPI:1811731219
Name:BRYAN, KENDLE (LSW)
Entity type:Individual
Prefix:
First Name:KENDLE
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MARDALE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-2623
Mailing Address - Country:US
Mailing Address - Phone:856-685-8515
Mailing Address - Fax:
Practice Address - Street 1:10000 MIDLANTIC DR STE 101E
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1504
Practice Address - Country:US
Practice Address - Phone:848-997-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06688600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker