| Psychmed Llc | |
|
2354 Se 59th Ave Portland OR 97215-4018 | |
| (503) 516-9308 | |
| Not Available |
| Full Name | Psychmed Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2354 Se 59th Ave, Portland, Oregon |
| Authorized Official Name and Position | Patrice D Carrello (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5035169308 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychmed Llc Po Box 12745 Salem OR 97309-0745 Ph: (503) 516-9308 | Psychmed Llc 2354 Se 59th Ave Portland OR 97215-4018 Ph: (503) 516-9308 |
| NPI Number | 1477862142 |
|---|---|
| Provider Enumeration Date | 09/29/2010 |
| Last Update Date | 09/29/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477862142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1626 (Oregon) | Primary |
| 163WP0808X | Registered Nurse - Psychiatric/mental Health | (* (Not Available)) | Secondary |
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