Healthcare Provider Details

I. General information

NPI: 1295877157
Provider Name (Legal Business Name): KRISTIN LAFERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 SILVER SPRING RD
PERRY HALL MD
21128-9659
US

IV. Provider business mailing address

2227 OLD EMMORTON ROAD SUITE 119
BEL AIR MD
21015
US

V. Phone/Fax

Practice location:
  • Phone: 410-529-5150
  • Fax: 410-569-0094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12147
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: