Provider Demographics
NPI:1578913505
Name:DICAIRANO, KENDALL
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:DICAIRANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LAKE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4519
Mailing Address - Country:US
Mailing Address - Phone:203-869-2030
Mailing Address - Fax:
Practice Address - Street 1:49 LAKE AVE STE 103
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4519
Practice Address - Country:US
Practice Address - Phone:203-869-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT800231H00000X
NY002612231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist