Provider Demographics
NPI:1093209389
Name:SHOSHANA D KEREWSKY PSYD LLC
Entity Type:Organization
Organization Name:SHOSHANA D KEREWSKY PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOSHANA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KEREWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:541-852-1900
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-0843
Mailing Address - Country:US
Mailing Address - Phone:541-852-1900
Mailing Address - Fax:541-393-9144
Practice Address - Street 1:132 E BROADWAY STE 331
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3154
Practice Address - Country:US
Practice Address - Phone:541-852-1900
Practice Address - Fax:541-393-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty