Provider Demographics
NPI:1851717078
Name:SHENANDOAH PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SHENANDOAH PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:540-251-7728
Mailing Address - Street 1:58 KENMORE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4338
Mailing Address - Country:US
Mailing Address - Phone:540-251-7728
Mailing Address - Fax:
Practice Address - Street 1:58 KENMORE ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4338
Practice Address - Country:US
Practice Address - Phone:540-251-7728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty