Provider Demographics
NPI:1164649752
Name:SMITH, KATHLEEN JOAN (MSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JOAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 GEORGIA AVE.
Mailing Address - Street 2:SUITE 808
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3614
Mailing Address - Country:US
Mailing Address - Phone:301-589-5089
Mailing Address - Fax:301-589-1471
Practice Address - Street 1:8720 GEORGIA AVE.
Practice Address - Street 2:SUITE 808
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3614
Practice Address - Country:US
Practice Address - Phone:301-589-5089
Practice Address - Fax:301-589-1471
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical