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General NPI Number Information
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NPI Number | 1770576175
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Entity Type | Individual
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Provider Name | KIM HALBACK LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 01/21/2023
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Provider Practice Location Address
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Address Line | 3311 TOLEDO TER STE B103
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City | HYATTSVILLE
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State | MD
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Zip | 20782-8146
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Country | US
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Telephone | 800-431-6377
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Fax | 866-936-0235
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Provider Business Mailing Address
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Address Line | 4006 BISHOPMILL DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-3405
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Country | US
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Telephone | 202-290-8335
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Fax | 866-936-0235
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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 | 6651
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License Number State | SC
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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 | LC50078515
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License Number State | DC
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