Basic Information
| Provider Information | |||||||||
| NPI: | 1659432789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOSMOPOULOS | ||||||||
| FirstName: | LIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MSW, PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2911 BLUERIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | WHEATON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209022685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019495740 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WALTER REED ARMY MEDICAL CTR | ||||||||
| Address2: | 6900 GEORGIA AVE NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023561012 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | LC302277 | DC | Y | Other Service Providers | Specialist |
No ID Information.