Provider Demographics
NPI:1215151964
Name:SMITH, KATHERINE A (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:A
Last Name:SMITH
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 1:2336 GODDARD PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1126
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:11120 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2970
Practice Address - Country:US
Practice Address - Phone:410-651-4200
Practice Address - Fax:410-651-4290
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522156095OtherAPS
MDLM49EAOtherCAREFIRST BCBS OF MARYLAND
MD522156095OtherCIGNA BEHAVIORAL HEALTH
MD522156095OtherMHNET BEHAVIORAL HEALTH
MDR968OtherCAREFIRST
MD346646OtherMHN
MD522156095OtherUBH
MD600478097OtherMAGELLAN BEHAVIORAL HEALTH
MD609550001Medicaid
MD609550004Medicaid
MD9772653OtherAETNA
MD9772653OtherAETNA