Healthcare Provider Details

I. General information

NPI: 1205047388
Provider Name (Legal Business Name): MEGHAN KOEHLER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 SENATE DR 1ST FLOOR
LANHAM MD
20706-4367
US

IV. Provider business mailing address

210 WOODHILL DR APT E
GLEN BURNIE MD
21061-5745
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-9840
  • Fax: 301-459-4856
Mailing address:
  • Phone: 443-995-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11398
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: