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1558376400

NPI Code Detail

MEDICARE: KATHEY JEAN LARGER LCSWC, LCPC

MEDICARE: KATHEY JEAN LARGER LCSWC, 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	1041C0700X	Clinical Social Worker	12992	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	346646	OTHER	MD	MANAGED HEALTH NETWORK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	517251	OTHER	MD	UNITED BEHAVIORAL HEALTH
5	499188	OTHER	MD	VO-MHA
6	LM49EA	OTHER	MD	CAREFIRST BCBS
7	522156095	OTHER	MD	TRICARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558376400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHEY JEAN LARGER LCSWC, LCPC

Provider Business Mailing Address
First Line	:	547 RIVERSIDE DR
Second Line	:	STE A
City	:	SALISBURY
State	:	MD
Zip	:	21801-5369
Country	:	US
Telephone Number	:	410-334-6961
Fax Number	:	410-334-6362

Provider Business Practice Location Address
First Line	:	1113 HEALTHWAY DR
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21804-4470
Country	:	US
Telephone Number	:	410-334-6961
Fax Number	:	410-334-6362

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/01/2021

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Directions to “ KATHEY JEAN LARGER LCSWC, LCPC” Practice Location

Language	Start Address	Practice Location

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