Provider Demographics
NPI:1902644636
Name:OTTEN, KAYE A (LCSW-C, LICSW)
Entity type:Individual
Prefix:
First Name:KAYE
Middle Name:A
Last Name:OTTEN
Suffix:
Gender:F
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20411 WESTERLY RD
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-9317
Mailing Address - Country:US
Mailing Address - Phone:404-353-1450
Mailing Address - Fax:
Practice Address - Street 1:1555 CONNECTICUT AVE NW STE 200E
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1126
Practice Address - Country:US
Practice Address - Phone:202-779-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000034311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical