Bacon, Kendall F

Bacon, Kendall F is an individual health care provider with primary practice located at 915 South St , Fitchburg MA 01420. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Bacon, Kendall F can be contacted via phone (978) 345-4147.

Contact Information

Primary practice address
915 South St Fitchburg MA 01420
Phone: (978) 345-4147
Fax: (978) 345-1616
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 105716 Massachusetts
Behavioral Health & Social Service Providers / Social Worker 104100000X 105716 Massachusetts
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 105716 Massachusetts

Profile Details

NPI number 1558344523
LBN Legal business name Bacon, Kendall F
Credentials MSW
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 23rd, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558344523 NPPES
Other 127184 TRICARE
Other P07079 TRICARE

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