Healthcare Provider Details

I. General information

NPI: 1508564345
Provider Name (Legal Business Name): KATELYN KENNELL-GAITHER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12502 WILLOWBROOK RD STE 380
CUMBERLAND MD
21502-6592
US

IV. Provider business mailing address

12502 WILLOWBROOK RD STE 300
CUMBERLAND MD
21502-6498
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-8793
  • Fax:
Mailing address:
  • Phone: 240-964-8793
  • Fax: 240-964-8679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number27836
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: