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General NPI Number Information
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NPI Number | 1851717078
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Entity Type | Organization
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Legal Business Name | SHENANDOAH PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 58 KENMORE ST
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City | HARRISONBURG
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State | VA
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Zip | 22801-4338
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Country | US
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Telephone | 540-251-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 58 KENMORE ST
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City | HARRISONBURG
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State | VA
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Zip | 22801-4338
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Country | US
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Telephone | 540-251-7728
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CASSANDRA KENNELL
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Credential | PSY.D.
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Telephone | 540-251-7728
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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 | 0810004930
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License Number State | VA
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