Healthcare Provider Details

I. General information

NPI: 1841901063
Provider Name (Legal Business Name): KAVITHA B. RAO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BOULEVARD SMYTH BUILDING SUITE 404
BALTIMORE MD
21239
US

IV. Provider business mailing address

5601 LOCH RAVEL BOULEVARD SMYTH BUILDING SUITE 404
BALTIMORE MD
21239
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-1120
  • Fax:
Mailing address:
  • Phone: 202-877-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007725
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number06864
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: