Provider Demographics
NPI:1982783346
Name:KASENDORF, EYDIE I (PHD)
Entity Type:Individual
Prefix:DR
First Name:EYDIE
Middle Name:I
Last Name:KASENDORF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2922
Mailing Address - Country:US
Mailing Address - Phone:508-845-7221
Mailing Address - Fax:
Practice Address - Street 1:48 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2922
Practice Address - Country:US
Practice Address - Phone:508-845-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY6561PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA329160OtherHPHC
MA735025OtherTUFTS
MA855201OtherPACIFICARE
MAW05217OtherBCBS
MA7706437OtherAETNA
MA1011530OtherBEACON (FALLON)
MA735025OtherTUFTS