Healthcare Provider Details

I. General information

NPI: 1619988433
Provider Name (Legal Business Name): KATHLEEN MARTEL CONNORS CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST 3RD. FLR.
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

701 W PRATT ST 3RD. FLR.
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-2539
  • Fax: 410-328-8552
Mailing address:
  • Phone: 410-328-2539
  • Fax: 410-328-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number06624
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: