Provider Demographics
NPI:1396247573
Name:RODRIGUEZ, KATHARINE DIANA (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:DIANA
Last Name:RODRIGUEZ
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 1:1706 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4814
Mailing Address - Country:US
Mailing Address - Phone:443-413-6099
Mailing Address - Fax:
Practice Address - Street 1:211 E FORT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4628
Practice Address - Country:US
Practice Address - Phone:443-708-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090417989104100000X
MD23024104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker