Provider Demographics
NPI:1265688709
Name:KASS, CONSTANTINA N (PHD)
Entity Type:Individual
Prefix:
First Name:CONSTANTINA
Middle Name:N
Last Name:KASS
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 1:47716 ALLEGHENY CIR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-4704
Mailing Address - Country:US
Mailing Address - Phone:703-297-1632
Mailing Address - Fax:
Practice Address - Street 1:6 PIGEON HILL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165
Practice Address - Country:US
Practice Address - Phone:703-763-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA26-1662010103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist