Basic Information
| Provider Information | |||||||||
| NPI: | 1003386541 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUZMENKO | ||||||||
| FirstName: | ALENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8401 JACKSON RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958263904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164531482 | ||||||||
| FaxNumber: | 9162838259 | ||||||||
| Practice Location | |||||||||
| Address1: | 3810 ROSIN CT | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162838280 | ||||||||
| FaxNumber: | 9162838259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2018 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6960 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 116234 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.