1215689591 NPI number — KYLA JANELLE DUHART LCSWC

Table of content: KYLA JANELLE DUHART LCSWC (NPI 1215689591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215689591 NPI number — KYLA JANELLE DUHART LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUHART
Provider First Name:
KYLA
Provider Middle Name:
JANELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSWC
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:
1215689591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 CAMBERLEY CIR APT A2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-0834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-534-2666
Provider Business Mailing Address Fax Number:
443-200-0267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 LONDONTOWN BLVD STE 130A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELDERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21784-6439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-356-9208
Provider Business Practice Location Address Fax Number:
443-200-0267
Provider Enumeration Date:
01/19/2022

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:  22980 , 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: 1932103926 . This is a "PRACTICE LOCATION" identifier . This identifiers is of the category "OTHER".




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