Healthcare Provider Details

I. General information

NPI: 1588511893
Provider Name (Legal Business Name): KATHRYN OMERSO, LCSW-C, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 ROSEMONT AVE
FREDERICK MD
21702-4135
US

IV. Provider business mailing address

1705 ROSEMONT AVE
FREDERICK MD
21702-4135
US

V. Phone/Fax

Practice location:
  • Phone: 240-366-1115
  • Fax:
Mailing address:
  • Phone: 240-366-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN OMERSO
Title or Position: OWNER
Credential: LCSW-C
Phone: 240-899-2089