| Doctor Name: | DR. KAREN DEISSEROTH CICHON |
| NPI Number: | 1023395621 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 0810003572 |
| Business Practice Address: | 3302 Gallows Rd Falls Church, VA - 220423353 |
| Business Phone Number: | 7032077100 |
| Business Fax Number: | |
| Mailing Address: | 3302 Gallows Rd, FALLS CHURCH |
| State: | VA |
| Postal Code: | 220423353 |
| Phone Number: | 7032077100 |
| Fax Number: | |
| NPI Enumeration Date: | 11/09/2011 |
| NPI Last Update Date: | 06/22/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0810003572 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |