1316170855 NPI number — KRISTEN ELIZABETH MCDERMOTT LCSW-C

Table of content: KRISTEN ELIZABETH MCDERMOTT LCSW-C (NPI 1316170855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316170855 NPI number — KRISTEN ELIZABETH MCDERMOTT LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDERMOTT
Provider First Name:
KRISTEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316170855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8258 VETERANS HWY
Provider Second Line Business Mailing Address:
SUITE 13
Provider Business Mailing Address City Name:
MILLERSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21108-1457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-768-6088
Provider Business Mailing Address Fax Number:
410-768-6444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8258 VETERANS HWY
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
MILLERSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21108-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-768-6088
Provider Business Practice Location Address Fax Number:
410-768-6444
Provider Enumeration Date:
09/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  SW127338 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 15276 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 214236800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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