MEDICARE: MALLEY K HESTER EVERNGAM 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	104100000X	Social Worker	25087	MD
2	1041C0700X	Clinical Social Worker	25087	MD

General Provider Information

NPI Number	:	1164045969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLEY K HESTER EVERNGAM LCSW-C

Provider Business Mailing Address
First Line	:	30103 RABBIT HILL RD
Second Line	:
City	:	EASTON
State	:	MD
Zip	:	21601-6555
Country	:	US
Telephone Number	:	410-829-7067
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 LOG CANOE CIR STE B-3
Second Line	:
City	:	STEVENSVILLE
State	:	MD
Zip	:	21666-2149
Country	:	US
Telephone Number	:	443-282-8720
Fax Number	:

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

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	04/29/2024

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