Healthcare Provider Details

I. General information

NPI: 1609082601
Provider Name (Legal Business Name): JANE CASSILLY KNAPP LCSW C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 HARFORD RD SUITE 204
FALLSTON MD
21047
US

IV. Provider business mailing address

1716 HARFORD RD SUITE 204
FALLSTON MD
21047
US

V. Phone/Fax

Practice location:
  • Phone: 410-877-7207
  • Fax: 410-877-7224
Mailing address:
  • Phone: 410-877-7207
  • Fax: 410-877-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07471
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierKC83
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST B C B S
# 2
IdentifierT460
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerBLUE CHOICE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: