Provider Demographics
NPI:1104185776
Name:KECMANOVIC, JELENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JELENA
Middle Name:
Last Name:KECMANOVIC
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 1:4824 41ST ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-1708
Mailing Address - Country:US
Mailing Address - Phone:202-557-5174
Mailing Address - Fax:
Practice Address - Street 1:2311 WILSON BLVD FL 3
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5436
Practice Address - Country:US
Practice Address - Phone:202-557-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical