Provider Demographics
NPI:1003453366
Name:MARYLAND CENTER FOR GENDER & INTIMACY
Entity Type:Organization
Organization Name:MARYLAND CENTER FOR GENDER & INTIMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-360-4349
Mailing Address - Street 1:319 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4855
Mailing Address - Country:US
Mailing Address - Phone:301-360-4349
Mailing Address - Fax:
Practice Address - Street 1:319 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4855
Practice Address - Country:US
Practice Address - Phone:301-360-4349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)