Individual
KENDALL F BACON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
915 SOUTH ST, FITCHBURG, MA 01420
(978) 345-4147
(978) 345-1616
Mailing address
855 MOUNTAIN RD, JAFFREY, NH 03452
(603) 532-8615
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
105716
MA
104100000X
Social Worker
105716
MA
106H00000X
Marriage & Family Therapist
Primary
105716
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127184
TRICARE
—
01
—
P07079
BCBS
MA
Enumeration date
11/23/2005
Last updated
09/11/2025
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