Healthcare Provider Details

I. General information

NPI: 1326007634
Provider Name (Legal Business Name): KAITLIN M WALDRIP LCSW C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 TALBOT ST UNIT L
ST MICHAELS MD
21663
US

IV. Provider business mailing address

PO BOX 660 301 RANDOLPH ST
DENTON MD
21629
US

V. Phone/Fax

Practice location:
  • Phone: 410-745-5020
  • Fax: 410-745-0492
Mailing address:
  • Phone: 410-479-4306
  • Fax: 410-479-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number06847
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: