Provider Demographics
NPI:1154433282
Name:SCAGNELLI, KIM CASEY (LCSW - C)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:CASEY
Last Name:SCAGNELLI
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 1:1702 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4504
Mailing Address - Country:US
Mailing Address - Phone:410-367-6545
Mailing Address - Fax:410-367-8158
Practice Address - Street 1:1702 SOUTH RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4504
Practice Address - Country:US
Practice Address - Phone:410-367-6545
Practice Address - Fax:410-367-8158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health