MEDICARE: MS. KATHLEEN GRAU 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	1013	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QT20K	OTHER	MD	PROVIDER ID

General Provider Information

NPI Number	:	1184779035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN GRAU LCSW-C

Provider Business Mailing Address
First Line	:	5054 DORSEY HALL DR
Second Line	:	SUITE 104
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7744
Country	:	US
Telephone Number	:	410-720-3144
Fax Number	:	410-992-1833

Provider Business Practice Location Address
First Line	:	5054 DORSEY HALL DR
Second Line	:	SUITE 104
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7744
Country	:	US
Telephone Number	:	410-720-3144
Fax Number	:	410-992-1833

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	06/21/2012

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