Healthcare Provider Details

I. General information

NPI: 1942097936
Provider Name (Legal Business Name): KATHLEEN TEWEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 WEEPING CHERRY CT
ELDERSBURG MD
21784-8557
US

IV. Provider business mailing address

806 WEEPING CHERRY CT
ELDERSBURG MD
21784-8557
US

V. Phone/Fax

Practice location:
  • Phone: 410-591-8820
  • Fax:
Mailing address:
  • Phone: 410-591-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR248851
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC17760
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: