Provider Demographics
NPI:1861090979
Name:ESPINOZA, KENNDRA (LCSW)
Entity type:Individual
Prefix:
First Name:KENNDRA
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2705
Mailing Address - Country:US
Mailing Address - Phone:860-347-6971
Mailing Address - Fax:860-343-7379
Practice Address - Street 1:395 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4924
Practice Address - Country:US
Practice Address - Phone:860-585-5000
Practice Address - Fax:860-585-5050
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT156671041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program