Healthcare Provider Details

I. General information

NPI: 1053530659
Provider Name (Legal Business Name): TERESA KAY ELLIOTT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KINGSBURY 5000 14TH STREET N.W.
WASHINGTON DC
20011-6926
US

IV. Provider business mailing address

KINGSBURY 5000 14TH STREET N.W.
WASHINGTON DC
20011-6926
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-2418
  • Fax: 202-722-5554
Mailing address:
  • Phone: 202-545-2418
  • Fax: 202-722-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY1888
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1888
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY1888
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1888
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY1888
License Number StateDC
# 6
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY1888
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY1888
License Number StateDC
# 8
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY1888
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: