Provider Demographics
NPI:1124344072
Name:EGOLF, KATHRYN (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:EGOLF
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 BENFIELD BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2639
Mailing Address - Country:US
Mailing Address - Phone:410-952-5902
Mailing Address - Fax:410-987-4710
Practice Address - Street 1:1110 BENFIELD BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2639
Practice Address - Country:US
Practice Address - Phone:410-952-5902
Practice Address - Fax:410-987-4710
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-18
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical