Provider Demographics
NPI:1760693717
Name:KANZLER, KATHRYN E (PSYD, ABPP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:KANZLER
Suffix:
Gender:F
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:KANZLER
Other - Last Name:APPOLONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 W PERIMETER RD
Mailing Address - Street 2:779 MDOS/SGOW
Mailing Address - City:ANDREWS AIR FORCE BASE
Mailing Address - State:MD
Mailing Address - Zip Code:20762-6601
Mailing Address - Country:US
Mailing Address - Phone:240-857-1610
Mailing Address - Fax:
Practice Address - Street 1:1050 W PERIMETER RD
Practice Address - Street 2:779 MDOS/SGOW
Practice Address - City:ANDREWS AIR FORCE BASE
Practice Address - State:MD
Practice Address - Zip Code:20762-6601
Practice Address - Country:US
Practice Address - Phone:240-857-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1755103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth