Provider Demographics
NPI:1447356456
Name:KENDALL, JUDITH LYNNE (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LYNNE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:L
Other - Last Name:KENDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:PO BOX 6325
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-0325
Mailing Address - Country:US
Mailing Address - Phone:415-747-5411
Mailing Address - Fax:
Practice Address - Street 1:3230 KERNER BLVD
Practice Address - Street 2:C/O MARIN COMMUNITY MENTAL HEALTH
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-473-2664
Practice Address - Fax:415-473-2353
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 38341106H00000X
CAIMF 52769106H00000X
CAMFC47481106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist