Healthcare Provider Details

I. General information

NPI: 1104185776
Provider Name (Legal Business Name): JELENA KECMANOVIC PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 WILSON BLVD FL 3
ARLINGTON VA
22201-5436
US

IV. Provider business mailing address

4824 41ST ST NW
WASHINGTON DC
20016-1708
US

V. Phone/Fax

Practice location:
  • Phone: 202-557-5174
  • Fax:
Mailing address:
  • Phone: 202-557-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004572
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: