Organization
KENNEMER & SMITH PSYCHOLOGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALENE CERASUOLO (OFFICE ADMINISTRATOR)
(503) 303-4257
Entity
Organization
Contact information
Practice address
619 MADISON ST STE 108, OREGON CITY, OR 97045-2354
(503) 303-4257
(503) 387-3957
Mailing address
619 MADISON ST STE 108, OREGON CITY, OR 97045-2354
(503) 303-4257
(503) 387-3957
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500602612
—
OR
Enumeration date
11/11/2020
Last updated
11/16/2020
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