Healthcare Provider Details

I. General information

NPI: 1316170855
Provider Name (Legal Business Name): KRISTEN ELIZABETH MCDERMOTT LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CROMWELL BRIDGE RD STE 312
TOWSON MD
21286-3331
US

IV. Provider business mailing address

1001 CROMWELL BRIDGE RD STE 312
TOWSON MD
21286-3331
US

V. Phone/Fax

Practice location:
  • Phone: 410-846-0095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15276
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW127338
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier214236800
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: