Provider Demographics
NPI:1811975220
Name:SCHROTH-MEYER, KIMBERLY L (LCSW-C & LCADC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:SCHROTH-MEYER
Suffix:
Gender:F
Credentials:LCSW-C & LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LLEWELLYN AVE STE 5800
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5129
Mailing Address - Country:US
Mailing Address - Phone:301-619-8105
Mailing Address - Fax:
Practice Address - Street 1:2480 LLEWELLYN AVE STE 5800
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5129
Practice Address - Country:US
Practice Address - Phone:301-619-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD099181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS285-460XMedicare ID - Type Unspecified
MDS70394Medicare UPIN