Provider Demographics
NPI:1093846222
Name:KANE, STEVEN R (PHD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:KANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 CUSHING DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4405 E WEST HWY
Practice Address - Street 2:STE 501
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4536
Practice Address - Country:US
Practice Address - Phone:240-476-8764
Practice Address - Fax:301-933-5265
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04040103TC0700X
DCPSY1000141103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4112202 00Medicaid
MD8341028 00Medicaid