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General NPI Number Information
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NPI Number | 1114291234
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Entity Type | Organization
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Legal Business Name | KAISER PERMANENTE
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 10500 SUMMIT AVENUE
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City | KENSINGTON
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State | MD
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Zip | 20895
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Country | US
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Telephone | 301-897-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 10500 SUMMIT AVENUE
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City | KENSINGTON
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State | MD
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Zip | 20895
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Country | US
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Telephone | 301-897-2500
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST II
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Name | BARRY LEE FORREST
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Credential | LCSW-C
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Telephone | 240-620-1399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 13240
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License Number State | MD
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