Provider Demographics
NPI:1124633144
Name:KREITZER, KEREN (MA, CAS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:KEREN
Middle Name:
Last Name:KREITZER
Suffix:
Gender:F
Credentials:MA, CAS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 INTERNATIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5537
Mailing Address - Country:US
Mailing Address - Phone:410-598-3872
Mailing Address - Fax:
Practice Address - Street 1:29 INTERNATIONAL CIR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5537
Practice Address - Country:US
Practice Address - Phone:410-598-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool