Healthcare Provider Details

I. General information

NPI: 1649871435
Provider Name (Legal Business Name): KOURTNEY GREEN HADDEN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 N POTOMAC ST
HAGERSTOWN MD
21740-3820
US

IV. Provider business mailing address

305 BROADMOOR RD
BALTIMORE MD
21212-3808
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1901
  • Fax:
Mailing address:
  • Phone: 859-382-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26384
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: