Healthcare Provider Details

I. General information

NPI: 1265688709
Provider Name (Legal Business Name): CONSTANTINA N KASS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 CHAIN BRIDGE RD # 305
MC LEAN VA
22101-3904
US

IV. Provider business mailing address

305 S CEDAR AVE
WOOD DALE IL
60191-2211
US

V. Phone/Fax

Practice location:
  • Phone: 703-297-1632
  • Fax:
Mailing address:
  • Phone: 703-297-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number26-1662010
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: