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General NPI Number Information
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NPI Number | 1215211396
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Entity Type | Individual
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Provider Name | KENNETH PHILIP SAUSEN PHD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2011
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-5269
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Fax |
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Provider Business Mailing Address
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Address Line | 134 TORRINGTON CIR
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City | SUFFOLK
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State | VA
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Zip | 23436-1140
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Country | US
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Telephone | 858-414-9192
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1272
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License Number State | NM
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