Provider Demographics
NPI:1962554337
Name:KENDRIGAN, HOLLY A (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:KENDRIGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 METRO PKWY
Mailing Address - Street 2:STE 205
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9416
Mailing Address - Country:US
Mailing Address - Phone:561-747-2775
Mailing Address - Fax:561-747-1881
Practice Address - Street 1:4425 MILITARY TRAIL
Practice Address - Street 2:STE. 203
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4817
Practice Address - Country:US
Practice Address - Phone:561-747-2775
Practice Address - Fax:561-747-1881
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW57401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical