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General NPI Number Information
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NPI Number | 1922772417
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Entity Type | Individual
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Provider Name | KATHY D MORAN LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 4800 ROLAND AVE STE 300
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City | BALTIMORE
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State | MD
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Zip | 21210-2347
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Country | US
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Telephone | 443-691-4131
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Fax |
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Provider Business Mailing Address
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Address Line | 7407 KNOLLWOOD RD
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City | TOWSON
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State | MD
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Zip | 21286-7928
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Country | US
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Telephone | 443-691-4131
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 05271
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License Number State | MD
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