MEDICARE: CAPITAL THERAPIST COLLECTIVE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1366191843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL THERAPIST COLLECTIVE PLLC

Provider Business Mailing Address
First Line	:	316 F ST NE STE 200
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-4939
Country	:	US
Telephone Number	:	202-656-1648
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 F ST NE STE 200
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-4939
Country	:	US
Telephone Number	:	202-656-1648
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEREMY JOZEF KOZNE
Credential	:	PH.D.
Telephone Number	:	202-656-1648

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	05/12/2022

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