Provider Demographics
NPI:1922240134
Name:PANKOPF, KRISTIN OLSEN (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:OLSEN
Last Name:PANKOPF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2301 RESEARCH BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3204
Mailing Address - Country:US
Mailing Address - Phone:301-424-5200
Mailing Address - Fax:
Practice Address - Street 1:2301 RESEARCH BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3204
Practice Address - Country:US
Practice Address - Phone:301-424-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical