MEDICARE: DR. TAKANORI KENNETH ENDO PSY.D.

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1346654019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAKANORI KENNETH ENDO PSY.D.

Provider Business Mailing Address
First Line	:	1300 CRESTWOOD CT S
Second Line	:	#1318
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-4924
Country	:	US
Telephone Number	:	305-490-1498
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 CRESTWOOD CT S
Second Line	:	#1318
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-4924
Country	:	US
Telephone Number	:	305-490-1498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	06/20/2014

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