Provider Demographics
NPI:1851940258
Name:HANSCOM, KENDRA S (LCSW)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:S
Last Name:HANSCOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:S
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9 HEALTHCARE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9450
Mailing Address - Country:US
Mailing Address - Phone:207-282-7531
Mailing Address - Fax:207-294-3555
Practice Address - Street 1:9 HEALTHCARE DR STE 208
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9450
Practice Address - Country:US
Practice Address - Phone:207-282-7531
Practice Address - Fax:207-294-3555
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC213831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078870Medicaid