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General NPI Number Information
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NPI Number | 1487262838
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Entity Type | Individual
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Provider Name | JENNIFER LANUZGA KALISH PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 7007 BRADLEY BLVD
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City | BETHESDA
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State | MD
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Zip | 20817-2149
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Country | US
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Telephone | 301-767-1733
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Fax |
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Provider Business Mailing Address
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Address Line | 7820B WORMANS MILL RD BX 239
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City | FREDERICK
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State | MD
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Zip | 21701
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Country | US
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Telephone | 301-450-1273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 06937
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License Number State | MD
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