Healthcare Provider Details

I. General information

NPI: 1306836630
Provider Name (Legal Business Name): DARLENE KASENBERG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CLEVELAND AVE
LOVELAND CO
80538-3835
US

IV. Provider business mailing address

1501 CLEVELAND AVE
LOVELAND CO
80538-3835
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-4816
  • Fax: 970-663-5601
Mailing address:
  • Phone: 970-495-4816
  • Fax: 970-663-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1188
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: