Provider Demographics
NPI:1003949728
Name:CHADWICK, KIRSTEN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:J
Last Name:CHADWICK
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 1:8513 RAYBURN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3827
Mailing Address - Country:US
Mailing Address - Phone:301-897-9480
Mailing Address - Fax:
Practice Address - Street 1:4545 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 417
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-6042
Practice Address - Country:US
Practice Address - Phone:202-558-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000180103TC0700X
MD3621103TC0700X
VA0810000355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical