Provider Demographics
NPI:1154121606
Name:RADFORD, LACI KATHLEEN
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:KATHLEEN
Last Name:RADFORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 DUCKETTS LN
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6121
Mailing Address - Country:US
Mailing Address - Phone:301-219-3406
Mailing Address - Fax:
Practice Address - Street 1:516 N ROLLING RD STE 201B
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4490
Practice Address - Country:US
Practice Address - Phone:443-846-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical