Healthcare Provider Details

I. General information

NPI: 1093785339
Provider Name (Legal Business Name): KATHLEEN KLEMER GUMIENNY LCSW C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 PIERCE ST #305
KINGSTON PA
18704-5512
US

IV. Provider business mailing address

2031 RUDY SERRA DR UNIT 3A
SYKESVILLE MD
21784-6552
US

V. Phone/Fax

Practice location:
  • Phone: 410-991-2077
  • Fax: 570-696-1526
Mailing address:
  • Phone: 410-991-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCWO15775
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number07971
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: