=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235701228
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIE LOMANGINO LCSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2021
-----------------------------------------------------
Last Update Date | 04/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4132 E JOPPA RD STE 110-1335
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21236-2272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-749-9344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4990 MERCANTILE RD UNIT 43913
-----------------------------------------------------
City | NOTTINGHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21236-8540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-353-7511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 26376
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 097346
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------