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General NPI Number Information
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NPI Number | 1003870411
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE BAXLEY LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 9000 ROCKVILLE PIKE BLDG 10
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 240-274-8464
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Fax |
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Provider Business Mailing Address
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Address Line | 4900 MOORLAND LN APT 628
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City | BETHESDA
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State | MD
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Zip | 20814-6299
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Country | US
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Telephone | 410-926-4703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW011254L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50077815
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License Number State | DC
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