Provider Demographics
NPI:1114370012
Name:KENKARE, KOMAL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:KENKARE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RESERVOIR ST STE 21
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3133
Mailing Address - Country:US
Mailing Address - Phone:781-449-1143
Mailing Address - Fax:781-449-5992
Practice Address - Street 1:220 RESERVOIR ST STE 21
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3133
Practice Address - Country:US
Practice Address - Phone:781-449-1143
Practice Address - Fax:781-449-5992
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2300320363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2300320OtherNURSE PRACTITIONER LICENSE NUMBER