Healthcare Provider Details

I. General information

NPI: 1609050343
Provider Name (Legal Business Name): KATHLEEN DEBRA HOGAN BRUEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW SUITE 400 THE ROSS CENTER
WASHINGTON DC
20015
US

IV. Provider business mailing address

5225 WISCONSIN AVE NW SUITE 400 THE ROSS CENTER
WASHINGTON DC
20015
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-1010
  • Fax: 202-363-2383
Mailing address:
  • Phone: 202-363-1010
  • Fax: 202-363-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1000265
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: