Active NPI
Kathleen Diane Kozma, PH.D.
- Clinical Psychologist
- Ashburn, VA
National Provider Identifier
1194930248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810002029
- Practice address
- 20604 Gordon Park SQ
#190
Ashburn, VA 20147-3143 - Phone
- (703) 726-7544
- NPI assigned
- May 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810002029 | VA | Primary |
Addresses
Primary practice location
20604 Gordon Park SQ
#190
Ashburn, VA 20147-3143
Mailing address
20604 Gordon Park SQ
#190
Ashburn, VA 20147-3143
Phone (703) 726-7544
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 29, 2024 through Mar 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810002029 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363651200000",
"number": "1194930248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20604 GORDON PARK SQ",
"address_2": "#190",
"city": "ASHBURN",
"state": "VA",
"postal_code": "201473143",
"telephone_number": "703-726-7544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20604 GORDON PARK SQ",
"address_2": "#190",
"city": "ASHBURN",
"state": "VA",
"postal_code": "201473143",
"telephone_number": "703-726-7544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOZMA",
"first_name": "KATHLEEN",
"middle_name": "DIANE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-11",
"last_updated": "2013-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810002029",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ashburn, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.