Provider Demographics
NPI:1003162397
Name:KAZEMBA, KARA RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:RAE
Last Name:KAZEMBA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:RAE
Other - Last Name:KAZEMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 W MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3991
Mailing Address - Country:US
Mailing Address - Phone:971-238-4408
Mailing Address - Fax:
Practice Address - Street 1:328 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-3991
Practice Address - Country:US
Practice Address - Phone:971-238-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA317311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical