Provider Demographics
NPI:1063902989
Name:COLE, KENDRA ELAINE (MA)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:ELAINE
Last Name:COLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3507
Mailing Address - Country:US
Mailing Address - Phone:860-740-2228
Mailing Address - Fax:860-254-7256
Practice Address - Street 1:41 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3507
Practice Address - Country:US
Practice Address - Phone:860-740-2228
Practice Address - Fax:860-254-7256
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2677106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1598176018OtherMEDICAID