Provider Demographics
NPI:1205541109
Name:KIRCANSKI, KATHARINA (PHD)
Entity type:Individual
Prefix:
First Name:KATHARINA
Middle Name:
Last Name:KIRCANSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 78TH ST
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1309
Mailing Address - Country:US
Mailing Address - Phone:401-487-0580
Mailing Address - Fax:
Practice Address - Street 1:1595 SPRING HILL RD STE 520
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-4101
Practice Address - Country:US
Practice Address - Phone:703-687-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical