Organization
PSYCHMED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICE D CARRELLO PHD (CLINICAL PSYCHOLOGIST)
(503) 516-9308
Entity
Organization
Contact information
Practice address
2354 SE 59TH AVE, PORTLAND, OR 97215-4018
(503) 516-9308
Mailing address
PO BOX 12745, SALEM, OR 97309-0745
(503) 516-9308
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1626
OR
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
Other
Enumeration date
09/29/2010
Last updated
09/29/2010
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