Provider Demographics
NPI:1124174578
Name:MENENDEZ, KATHRYN ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANN
Last Name:MENENDEZ
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 1:1212 E OSBORN RD
Mailing Address - Street 2:STE. 106
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5533
Mailing Address - Country:US
Mailing Address - Phone:602-265-9555
Mailing Address - Fax:602-234-7923
Practice Address - Street 1:1212 E OSBORN RD
Practice Address - Street 2:STE. 106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5533
Practice Address - Country:US
Practice Address - Phone:602-265-9555
Practice Address - Fax:602-234-7923
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1083103T00000X, 103TF0200X
FL4818103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic