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General NPI Number Information
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NPI Number | 1992613855
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Entity Type | Individual
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Provider Name | KENDRA MICKENS
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Gender | Female
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 225 E CITY AVE STE 104
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1724
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Country | US
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Telephone | 717-268-9479
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Fax |
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Provider Business Mailing Address
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Address Line | 5901 NASSAU RD STE 1
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City | PHILADELPHIA
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State | PA
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Zip | 19151-3540
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Country | US
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Telephone | 267-314-9477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW143260
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License Number State | PA
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