MEDICARE: MS. DEBORAH BRADER KIDWELL LCPC

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	101YP2500X	Professional Counselor	LC4030	MD

General Provider Information

NPI Number	:	1407180862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH BRADER KIDWELL LCPC

Provider Business Mailing Address
First Line	:	2141 LOVE POINT RD
Second Line	:
City	:	STEVENSVILLE
State	:	MD
Zip	:	21666-2051
Country	:	US
Telephone Number	:	410-703-2816
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 SAINT CLAIRE PL STE 202
Second Line	:
City	:	STEVENSVILLE
State	:	MD
Zip	:	21666-2193
Country	:	US
Telephone Number	:	410-703-2816
Fax Number	:

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

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	06/09/2023

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