1215151964 NPI number — MS. KATHERINE A. SMITH LCSW-C

Table of content: MS. KATHERINE A. SMITH LCSW-C (NPI 1215151964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215151964 NPI number — MS. KATHERINE A. SMITH LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
KATHERINE
Provider Middle Name:
A.
Provider Name Prefix Text:
MS.
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:
1215151964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2336 GODDARD PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-334-6961
Provider Business Mailing Address Fax Number:
410-334-6362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11120 SOMERSET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCESS ANNE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21853-2970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-651-4200
Provider Business Practice Location Address Fax Number:
410-651-4290
Provider Enumeration Date:
04/12/2007

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: 1041C0700X , with the licence number:  13691 , 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: 522156095 . This is a "APS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LM49EA . This is a "CAREFIRST BCBS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "MHNET BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R968 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 346646 . This is a "MHN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "UBH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 600478097 . This is a "MAGELLAN BEHAVIORAL HEALTH" 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: 609550004 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9772653 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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