Provider Demographics
NPI:1962976571
Name:KENDALL, NIKE A (LICSW)
Entity type:Individual
Prefix:MS
First Name:NIKE
Middle Name:A
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:NIKE
Other - Middle Name:A
Other - Last Name:SILVESTRINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PROGRAM IN WOMEN'S ONCOLOGY
Mailing Address - Street 2:101 DUDLEY STREET
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-430-7211
Mailing Address - Fax:401-453-7529
Practice Address - Street 1:PROGRAM IN WOMEN'S ONCOLOGY
Practice Address - Street 2:101 DUDLEY STREET
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-430-7211
Practice Address - Fax:401-453-7529
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW013101041C0700X
RIISW024661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical