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Organization

KINERA FOUNDATION, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTY RUSSELL (PRESIDENT)
(443) 926-6483
Entity
Organization

Contact information

Practice address
115 SALLITT DR, SUITE C, STEVENSVILLE, MD 21666-2156
(443) 926-6483
Mailing address
115 SALLITT DR, SUITE C, STEVENSVILLE, MD 21666-2156
(443) 926-6483

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
225XP0200X
Pediatric Occupational Therapist
Primary
235Z00000X
Speech-Language Pathologist

Other

Enumeration date
03/15/2016
Last updated
01/06/2017
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