Basic Information
Provider Information
NPI: 1124138342
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOHLENBERG
FirstName: BARBARA
MiddleName:  
NamePrefix: PROF.
NameSuffix:  
Credential: P.H.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 401 W 2ND ST
Address2: 235D
City: RENO
State: NV
PostalCode: 895035345
CountryCode: US
TelephoneNumber: 7756828175
FaxNumber: 7753272006
Practice Location
Address1: 5190 NEIL RD
Address2: 215
City: RENO
State: NV
PostalCode: 895026599
CountryCode: US
TelephoneNumber: 7757844917
FaxNumber: 7757841428
Other Information
ProviderEnumerationDate: 08/30/2006
LastUpdateDate: 11/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000XPY0326NVY Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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