Provider Demographics
NPI:1093489478
Name:RUPPERT, KIERAN (LMSW)
Entity Type:Individual
Prefix:
First Name:KIERAN
Middle Name:
Last Name:RUPPERT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 INGRAM RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3718
Mailing Address - Country:US
Mailing Address - Phone:443-648-5744
Mailing Address - Fax:
Practice Address - Street 1:1725 INGRAM RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3718
Practice Address - Country:US
Practice Address - Phone:443-648-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty