Provider Demographics
NPI:1003386541
Name:KUZMENKO, ALENA
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:KUZMENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W Q ST
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-1211
Mailing Address - Country:US
Mailing Address - Phone:916-225-5551
Mailing Address - Fax:
Practice Address - Street 1:112 W Q ST
Practice Address - Street 2:
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-1211
Practice Address - Country:US
Practice Address - Phone:916-225-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6960101YM0800X
CA116234106H00000X
CA141164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health