Provider Demographics
NPI:1215505920
Name:ROSSI, KATHERINE KEYSER (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:KEYSER
Last Name:ROSSI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:255 TEALL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13406-2013
Mailing Address - Country:US
Mailing Address - Phone:703-517-4157
Mailing Address - Fax:
Practice Address - Street 1:1707 BELLE VIEW BLVD APT A2
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6727
Practice Address - Country:US
Practice Address - Phone:703-517-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005196103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235745936OtherMOUNT VERNON FAMILY THERAPY
VA1710363924OtherKATE KEYSER ROSSI, PSY.D., LLC