Provider Demographics
NPI:1922897743
Name:SELAH, KATHARINE BERENSON
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:BERENSON
Last Name:SELAH
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 1:7024 SE CORA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3459
Mailing Address - Country:US
Mailing Address - Phone:917-951-1437
Mailing Address - Fax:
Practice Address - Street 1:1800 SW 1ST AVE STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5355
Practice Address - Country:US
Practice Address - Phone:917-951-1437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent