Provider Demographics
NPI:1689982274
Name:LANDSINGER, KRISTIN LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LYNN
Last Name:LANDSINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LYNN
Other - Last Name:SOMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 BLAKE ROAD
Mailing Address - Street 2:LEAD DIVISION, US NAVAL ACADEMY
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21402-1305
Mailing Address - Country:US
Mailing Address - Phone:410-293-6023
Mailing Address - Fax:
Practice Address - Street 1:INTREPID SPIRIT CONCUSSION RECOVERY CENTER
Practice Address - Street 2:180 HOSPITAL CORPS BLVD.
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-449-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
AZPSY-004293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical