Healthcare Provider Details

I. General information

NPI: 1306213095
Provider Name (Legal Business Name): ALAN KUTNER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8114 SANDPIPER CIR STE 205
NOTTINGHAM MD
21236
US

IV. Provider business mailing address

8114 SANDPIPER CIR
NOTTINGHAM MD
21236-4934
US

V. Phone/Fax

Practice location:
  • Phone: 443-485-4573
  • Fax:
Mailing address:
  • Phone: 443-485-5473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23667
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: