Provider Demographics
NPI:1487938395
Name:MALTAIS, KENDRA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:MARIE
Last Name:MALTAIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:MARIE
Other - Last Name:LIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:12 METHUEN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1700
Mailing Address - Country:US
Mailing Address - Phone:978-726-0522
Mailing Address - Fax:978-620-1794
Practice Address - Street 1:12 METHUEN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1700
Practice Address - Country:US
Practice Address - Phone:978-620-1795
Practice Address - Fax:978-620-1794
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker