Healthcare Provider Details

I. General information

NPI: 1104937986
Provider Name (Legal Business Name): NICOLE JEAN KAISER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LOCH RAVEN BLVD
BALTIMORE MD
21218-2108
US

IV. Provider business mailing address

2131 BEACH DR
PASADENA MD
21122-5705
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7633
  • Fax: 410-605-7691
Mailing address:
  • Phone: 410-255-5519
  • Fax: 410-605-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13630
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: