MEDICARE: KATHLEEN KLEMER GUMIENNY LCSW C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CWO15775	PA
2	104100000X	Social Worker	07971	MD

General Provider Information

NPI Number	:	1093785339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN KLEMER GUMIENNY LCSW C

Provider Business Mailing Address
First Line	:	2031 RUDY SERRA DR UNIT 3A
Second Line	:
City	:	SYKESVILLE
State	:	MD
Zip	:	21784-6552
Country	:	US
Telephone Number	:	410-991-2077
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 PIERCE ST
Second Line	:	#305
City	:	KINGSTON
State	:	PA
Zip	:	18704-5512
Country	:	US
Telephone Number	:	410-991-2077
Fax Number	:	570-696-1526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	02/25/2025

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