Healthcare Provider Details

I. General information

NPI: 1710363924
Provider Name (Legal Business Name): KATE KEYSER ROSSI, PSY.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 BELLE VIEW BLVD. A-2
ALEXANDRIA VA
22307
US

IV. Provider business mailing address

1707 BELLE VIEW BLVD. A-2
ALEXANDRIA VA
22307
US

V. Phone/Fax

Practice location:
  • Phone: 703-517-4157
  • Fax:
Mailing address:
  • Phone: 703-517-4157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0810005196
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0810005196
License Number StateVA

VIII. Authorized Official

Name: DR. KATHERINE R KEYSER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 703-517-4157