Provider Demographics
NPI:1104937986
Name:KAISER, NICOLE JEAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JEAN
Last Name:KAISER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-5705
Mailing Address - Country:US
Mailing Address - Phone:410-255-5519
Mailing Address - Fax:410-605-7676
Practice Address - Street 1:3900 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2108
Practice Address - Country:US
Practice Address - Phone:410-605-7633
Practice Address - Fax:410-605-7691
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13630104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker