Healthcare Provider Details

I. General information

NPI: 1659432789
Provider Name (Legal Business Name): LIZABETH ANN KOSMOPOULOS MSW, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVE NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

2911 BLUERIDGE AVE
WHEATON MD
20902-2685
US

V. Phone/Fax

Practice location:
  • Phone: 202-356-1012
  • Fax:
Mailing address:
  • Phone: 301-949-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLC302277
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: