Healthcare Provider Details

I. General information

NPI: 1780001982
Provider Name (Legal Business Name): KATHLEEN ARBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN SULLIVAN LCSW-C

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14350 SOLOMONS ISLAND RD. SUITE 202
SOLOMONS MD
20688
US

IV. Provider business mailing address

13101 WINDJAMMER AVE
SOLOMONS MD
20688-3025
US

V. Phone/Fax

Practice location:
  • Phone: 410-474-7285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11812
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: