Provider Demographics
NPI:1023359049
Name:MAHER, KIMBERLY ANN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:MAHER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 STREETT CIR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-3070
Mailing Address - Country:US
Mailing Address - Phone:443-327-9924
Mailing Address - Fax:
Practice Address - Street 1:2015 EMMORTON RD STE 201
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6180
Practice Address - Country:US
Practice Address - Phone:410-800-2169
Practice Address - Fax:410-777-8742
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8400181 00Medicaid