Provider Demographics
NPI:1942624267
Name:KAHN, BROOKE TANCER (PSYD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:TANCER
Last Name:KAHN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:JENNIFER
Other - Last Name:TANCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 PARK ST NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4602
Mailing Address - Country:US
Mailing Address - Phone:703-281-4928
Mailing Address - Fax:
Practice Address - Street 1:133 PARK ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4602
Practice Address - Country:US
Practice Address - Phone:703-281-4928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical