Provider Demographics
NPI:1548341324
Name:KOLENDA, JUDITH M (LADC,LPN,CAS,)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:KOLENDA
Suffix:
Gender:F
Credentials:LADC,LPN,CAS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3534
Mailing Address - Country:US
Mailing Address - Phone:617-661-5700
Mailing Address - Fax:
Practice Address - Street 1:260 BEACON ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3534
Practice Address - Country:US
Practice Address - Phone:617-661-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2045101YA0400X
MA50018164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse