Provider Demographics
NPI:1912376807
Name:BRIDEAU, KATHRYN HANNA (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HANNA
Last Name:BRIDEAU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 GUTHRIE AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-1818
Mailing Address - Country:US
Mailing Address - Phone:440-251-0220
Mailing Address - Fax:
Practice Address - Street 1:2016 MOUNT VERNON AVE STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-1367
Practice Address - Country:US
Practice Address - Phone:440-251-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005816103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist