Kendra Burnside, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904010222 Issued in VA

Practice address

2241 Tackett'S Mill Drive
Suite G
Lake Ridge, VA 22192

Phone

(703) 494-1434

NPI assigned

Sep 12, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523232000000",
    "number": "1548419641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2241 TACKETT'S MILL DRIVE",
            "address_2": "SUITE G",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-494-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2241 TACKETT'S MILL DRIVE",
            "address_2": "SUITE G",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-494-1434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNSIDE",
        "first_name": "KENDRA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-12",
        "last_updated": "2018-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "3544",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904010222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marvi Ibrahim Baloch
• Margaret W Becker, LCSW,CSAC
• Ursula Benton, COTA
• Brains That Bewonder Occupational Therapy, PLLC
• Matthew Stuart Broudy, PHD
• James H Chung, DPM
• Monique Michelle Colley, PA-C
• Anne Marie Compton, D.D.S.
• Beverly Conrad
• Gloria Cruz-Fontana, PT

• Clinical Social Worker in Lake Ridge, VA
• Providers in Lake Ridge, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.