Provider Demographics
NPI:1932252731
Name:MARIEN, KENDRA LYN (LCSW,MSW)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:LYN
Last Name:MARIEN
Suffix:
Gender:F
Credentials:LCSW,MSW
Other - Prefix:MRS
Other - First Name:KENDRA
Other - Middle Name:LYN
Other - Last Name:MARIEN-OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW,MSW
Mailing Address - Street 1:585 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1906
Mailing Address - Country:US
Mailing Address - Phone:508-854-3320
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:154 OAK ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3320
Practice Address - Country:US
Practice Address - Phone:508-898-1570
Practice Address - Fax:508-753-5051
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2103821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308785Medicaid
MAM18684OtherBCBS MENTAL HEALTH
MA2220002001OtherBCBS SUBSTANCE ABUSE
MA1306421Medicaid
MA1306421Medicaid