Basic Information
| Provider Information | |||||||||
| NPI: | 1962554337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENDRIGAN | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4310 METRO PKWY | ||||||||
| Address2: | STE 205 | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339169416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617472775 | ||||||||
| FaxNumber: | 5617471881 | ||||||||
| Practice Location | |||||||||
| Address1: | 4425 MILITARY TRAIL | ||||||||
| Address2: | STE. 203 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334584817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617472775 | ||||||||
| FaxNumber: | 5617471881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW5740 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.