Provider Demographics
NPI:1912937285
Name:KRAUS, MIMI (LCSW-C)
Entity type:Individual
Prefix:
First Name:MIMI
Middle Name:
Last Name:KRAUS
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 1:3506 GWYNNBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1409
Mailing Address - Country:US
Mailing Address - Phone:410-843-7523
Mailing Address - Fax:410-664-0115
Practice Address - Street 1:3506 GWYNNBROOK AVE
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1409
Practice Address - Country:US
Practice Address - Phone:410-843-7523
Practice Address - Fax:410-665-0115
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD041771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD221856OtherCOMPPSYCH
MD11265736OtherCAQH