Provider Demographics
NPI:1588152771
Name:SISTI, KALTHEEN MARIE (LGSW)
Entity type:Individual
Prefix:
First Name:KALTHEEN
Middle Name:MARIE
Last Name:SISTI
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 TOWER OAKS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4219
Mailing Address - Country:US
Mailing Address - Phone:301-468-1001
Mailing Address - Fax:301-468-1101
Practice Address - Street 1:3202 TOWER OAKS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4219
Practice Address - Country:US
Practice Address - Phone:301-468-1001
Practice Address - Fax:301-468-1101
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21082104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21082OtherLGSW GRADUATE