Healthcare Provider Details

I. General information

NPI: 1326233297
Provider Name (Legal Business Name): KISHMA M TROTMAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 LIBERTY HEIGHTS AVE
BALTIMORE MD
21215-8019
US

IV. Provider business mailing address

8246 CHURCH LN APT L
WINDSOR MILL MD
21244-5207
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-8300
  • Fax: 410-383-3160
Mailing address:
  • Phone: 410-917-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23258
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: