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General NPI Number Information
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NPI Number | 1588927495
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Entity Type | Organization
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Legal Business Name | KENDALL PSYCHOLOGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | ONE KENDALL SQUARE SUITE B14403
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City | CAMBRIDGE
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State | MA
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Zip | 02139
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Country | US
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Telephone | 617-388-7920
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Fax | 617-649-8846
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Provider Business Mailing Address
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Address Line | ONE KENDALL SQUARE SUITE B14403
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City | CAMBRIDGE
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State | MA
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Zip | 02139
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Country | US
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Telephone | 617-388-7920
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Fax | 617-649-8846
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ETHAN L SEIDMAN
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Credential | PH.D.
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Telephone | 617-388-7920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8218
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 8218
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License Number State | MA
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