Healthcare Provider Details

I. General information

NPI: 1639846520
Provider Name (Legal Business Name): KATHLEEN HEALY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST # 309
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

626 BERRY ST
BALTIMORE MD
21211-2524
US

V. Phone/Fax

Practice location:
  • Phone: 443-449-5604
  • Fax:
Mailing address:
  • Phone: 443-340-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21875
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: