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General NPI Number Information
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NPI Number | 1457964454
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Entity Type | Organization
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Legal Business Name | KATHARINE PETZOLD LCSW-C LLC
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 3 N HARRISON ST STE 206
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City | EASTON
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State | MD
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Zip | 21601-3146
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Country | US
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Telephone | 410-819-2150
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Fax |
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Provider Business Mailing Address
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Address Line | 520 TRIPPE AVE
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City | EASTON
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State | MD
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Zip | 21601-2521
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Country | US
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Telephone | 410-819-2150
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHARINE PETZOLD
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Credential | LCSW-C
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Telephone | 410-819-2150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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