Healthcare Provider Details

I. General information

NPI: 1396161428
Provider Name (Legal Business Name): KALIMAH MCRAE HARTWELL LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KALIMAH MCRAE

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MERCANTILE LN
LARGO MD
20774-5374
US

IV. Provider business mailing address

2939 SAINT HELEN CIR
SILVER SPRING MD
20906-2467
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-5500
  • Fax:
Mailing address:
  • Phone: 301-770-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13552
License Number StateMD

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: