Individual
DR. KENNETH ALLEN DEHERRERA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
DEPARTMENT OF THE ARMY, U.S. ARMY MEDICAL DEPARTMENT, ACTIVITY, FORT DRUM, NEW YORK, WATERETOWN, NY 13602-5004
(315) 772-3314
Mailing address
410 HOLCOMB ST, WATERTOWN, NY 13601-3907
(801) 450-4414
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
263423-2501
UT
Other
Enumeration date
05/23/2006
Last updated
07/08/2007
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