Provider Demographics
NPI:1306947809
Name:HENDRY, KARA MATILE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:MATILE
Last Name:HENDRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 47918
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743
Mailing Address - Country:US
Mailing Address - Phone:727-322-6123
Mailing Address - Fax:727-322-6143
Practice Address - Street 1:5348 1ST AVE N
Practice Address - Street 2:SUITE D
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8106
Practice Address - Country:US
Practice Address - Phone:727-322-6123
Practice Address - Fax:727-322-6143
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54889OtherBLUE CROSS BLUE SHIELD
FL55011000OtherMAGELLAN
FL687018079OtherBRAIN AND SPINAL CORD INJ
FLFL2056OtherBRADMAN NETWORK
FL3402278OtherAETNA
FL2179838OtherCIGNA BEHAVIORAL HEALTH
FL6870180701Medicaid
FLFL2056OtherBRADMAN NETWORK