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NPI Code Detail

MEDICARE: KATIE REBECCA WHITE LCSW-C

MEDICARE:   KATIE REBECCA WHITE  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
11041C0700XClinical Social Worker14453MD

General Provider Information

NPI Number : 1740625748
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE REBECCA WHITE LCSW-C
Provider Business Mailing Address
First Line : 3559 MCSHANE WAY
Second Line :
City : DUNDALK
State : MD
Zip : 21222-5958
Country : US
Telephone Number : 410-459-0856
Fax Number :
Provider Business Practice Location Address
First Line : 3559 MCSHANE WAY
Second Line :
City : DUNDALK
State : MD
Zip : 21222-5958
Country : US
Telephone Number : 410-459-0856
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2013
Last Update Date : 05/03/2013

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Directions to “ KATIE REBECCA WHITE LCSW-C” Practice Location

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