MEDICARE: MRS. KATE HATHAWAY BAGLI LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	09789	MD

General Provider Information

NPI Number	:	1629210349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATE HATHAWAY BAGLI LCSW-C

Provider Business Mailing Address
First Line	:	7600 OSLER DR STE 404
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21204-7703
Country	:	US
Telephone Number	:	410-377-8823
Fax Number	:	410-377-0006

Provider Business Practice Location Address
First Line	:	7600 OSLER DR STE 404
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21204-7703
Country	:	US
Telephone Number	:	410-377-8823
Fax Number	:	410-377-0006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	03/26/2009

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