Provider Demographics
NPI:1013215052
Name:COOK-DEEGAN, KATHRYN (MA, MPA, DIPLOMATE)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:COOK-DEEGAN
Suffix:
Gender:F
Credentials:MA, MPA, DIPLOMATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 18TH ST NW # 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1869
Mailing Address - Country:US
Mailing Address - Phone:202-738-0301
Mailing Address - Fax:
Practice Address - Street 1:1314 18TH ST NW # 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1869
Practice Address - Country:US
Practice Address - Phone:202-738-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT098.0064226103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis