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General NPI Number Information
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NPI Number | 1811059207
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Entity Type | Individual
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Provider Name | STACEY ILENE KALTMAN PHD
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3800 RESERVOIR RD NW 613 KOBER COGAN HALL
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City | WASHINGTON
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State | DC
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Zip | 20007-2113
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Country | US
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Telephone | 202-687-6571
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Fax | 202-687-0694
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Provider Business Mailing Address
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Address Line | 5225 POOKS HILL RD APT 820S
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City | BETHESDA
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State | MD
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Zip | 20814-2052
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Country | US
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Telephone | 301-493-4582
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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 | PSY1000157
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810002920
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License Number State | VA
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