Healthcare Provider Details

I. General information

NPI: 1124796925
Provider Name (Legal Business Name): KATE GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 BAY RIDGE AVE STE 190
ANNAPOLIS MD
21403-2834
US

IV. Provider business mailing address

5807 MIRIAM DR
ELDERSBURG MD
21784-8437
US

V. Phone/Fax

Practice location:
  • Phone: 443-281-9430
  • Fax:
Mailing address:
  • Phone: 443-789-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2102032-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: