Provider Demographics
NPI:1215088158
Name:GUSSMAN WOODS, KATHERINE (LCSW C)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:GUSSMAN WOODS
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:OLINE
Other - Last Name:GUSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW C
Mailing Address - Street 1:244 ST ANTONS WAY
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012
Mailing Address - Country:US
Mailing Address - Phone:410-647-5882
Mailing Address - Fax:
Practice Address - Street 1:1419 MADISON PARK DRIVE
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-768-2719
Practice Address - Fax:410-424-2983
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09450104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker