Provider Demographics
NPI:1558972927
Name:HARRIS, KENDRA C (LICSW)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WASHINGTON ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3506
Mailing Address - Country:US
Mailing Address - Phone:978-741-1800
Mailing Address - Fax:
Practice Address - Street 1:98 WASHINGTON ST FL 3
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3506
Practice Address - Country:US
Practice Address - Phone:978-741-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1258581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110196003AMedicaid