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NPI Code Detail

MEDICARE: KENDRA MICHAEL BCBA, LPA, PHD

MEDICARE: KENDRA MICHAEL BCBA, LPA, PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistA01018MD
2103K00000XBehavior Analyst1-19-35527

General Provider Information

NPI Number : 1043866395
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRA MICHAEL BCBA, LPA, PHD
Provider Business Mailing Address
First Line : 9632 BLOCK ST
Second Line :
City : LANHAM
State : MD
Zip : 20706-2585
Country : US
Telephone Number : 704-533-0147
Fax Number :
Provider Business Practice Location Address
First Line : 7120 SAMUEL MORSE DR
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3419
Country : US
Telephone Number : 888-344-5977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2019
Last Update Date : 06/23/2025

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