1215006598 NPI number — MRS. MARY E KAUL-BLACK LCSW C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215006598 NPI number — MRS. MARY E KAUL-BLACK LCSW C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KAUL-BLACK

Provider First Name:

MARY

Provider Middle Name:

E

Provider Name Prefix Text:

MRS.

Provider Name Suffix Text:

Provider Credential Text:

LCSW C

Provider Gender Code:

F

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:

1215006598

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/06/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

314 FRANKLIN AVE

Provider Second Line Business Mailing Address:

SUITE 306

Provider Business Mailing Address City Name:

BERLIN

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21811

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-973-2525

Provider Business Mailing Address Fax Number:

410-973-2527

Provider First Line Business Practice Location Address:

314 FRANKLIN AVE

Provider Second Line Business Practice Location Address:

SUITE 306

Provider Business Practice Location Address City Name:

BERLIN

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21811

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-973-2525

Provider Business Practice Location Address Fax Number:

410-973-2527

Provider Enumeration Date:

11/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1041C0700X , with the licence number:  11018 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0006 . This is a "CAREFIRST FEDERAL PIN DC" identifier . This identifiers is of the category "OTHER".
• Identifier: 259147000 . This is a "MAGELLAN GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 609550001 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 2101170 . This is a "UNITED HEALTH CARE MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: LM49EA . This is a "CAREFIRST BCBS GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: R968 . This is a "CARE1ST FEDERAL GROUP DC" identifier . This identifiers is of the category "OTHER".
• Identifier: 100075562001 . This is a "AMERICAN PSYCH SYSTEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 522156095 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 522156095 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 269292000 . This is a "MAGELLAN PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 517251 . This is a "UHC MAMSI GROUP #" identifier . This identifiers is of the category "OTHER".
• Identifier: 724333 . This is a "NCPPO PIN" identifier . This identifiers is of the category "OTHER".
• Identifier: 60956202 . This is a "CAREFIRST BCBS PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".