Healthcare Provider Details

I. General information

NPI: 1730873233
Provider Name (Legal Business Name): KATHARINE MAURY CROOK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
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

1229 HOPE RD
CENTREVILLE MD
21617-1909
US

V. Phone/Fax

Practice location:
  • Phone: 443-281-9430
  • Fax: 443-782-2446
Mailing address:
  • Phone: 410-490-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30095
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: