Provider Demographics
NPI:1083751291
Name:DEAN, KATHLEEN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:DEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 SPRINGWATER CT
Mailing Address - Street 2:APT. K
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4945
Mailing Address - Country:US
Mailing Address - Phone:410-902-1064
Mailing Address - Fax:410-902-1064
Practice Address - Street 1:12000 LINCOLN DR W
Practice Address - Street 2:SUITE 407
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3402
Practice Address - Country:US
Practice Address - Phone:856-985-3404
Practice Address - Fax:856-985-7847
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052137001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical