MEDICARE: DR. DARLENE KASENBERG PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	1188	CO

General Provider Information

NPI Number	:	1306836630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARLENE KASENBERG PH.D.

Provider Business Mailing Address
First Line	:	1501 CLEVELAND AVE
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3835
Country	:	US
Telephone Number	:	970-495-4816
Fax Number	:	970-663-5601

Provider Business Practice Location Address
First Line	:	1501 CLEVELAND AVE
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3835
Country	:	US
Telephone Number	:	970-495-4816
Fax Number	:	970-663-5601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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