Provider Demographics
NPI:1720529399
Name:FERRARA LOMBARDO, KATHLEEN (MA LCPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FERRARA LOMBARDO
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13766 BRIGHTON DAM RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1334
Mailing Address - Country:US
Mailing Address - Phone:443-538-1604
Mailing Address - Fax:
Practice Address - Street 1:13766 BRIGHTON DAM RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1334
Practice Address - Country:US
Practice Address - Phone:443-538-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional