Provider Demographics
NPI:1881720035
Name:COSGRAVE, CHRISTINE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:COSGRAVE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 EMERALD CHASE DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2334
Mailing Address - Country:US
Mailing Address - Phone:703-435-1447
Mailing Address - Fax:
Practice Address - Street 1:20905 PROFESSIONAL PLZ
Practice Address - Street 2:#230
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7783
Practice Address - Country:US
Practice Address - Phone:703-858-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003735103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical