Provider Demographics
NPI:1386301752
Name:ISSERMAN, KEVIN (PSYD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ISSERMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 KALORAMA RD NW APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1448
Mailing Address - Country:US
Mailing Address - Phone:850-712-7942
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 800
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1733
Practice Address - Country:US
Practice Address - Phone:202-986-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY200001271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical