Healthcare Provider Details

I. General information

NPI: 1962680645
Provider Name (Legal Business Name): KATHERINE ANN ROVENDRO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 OAK CT
ANNAPOLIS MD
21401-7017
US

IV. Provider business mailing address

PO BOX 3603
BALTIMORE MD
21214-0603
US

V. Phone/Fax

Practice location:
  • Phone: 410-254-0224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC2400
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: