Provider Demographics
NPI:1174025498
Name:SAVAGE, KENDALL ROSE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:ROSE
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 ADMIRAL COCHRANE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7600
Mailing Address - Country:US
Mailing Address - Phone:443-440-5788
Mailing Address - Fax:
Practice Address - Street 1:202 COURSEVALL DR STE 104
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2805
Practice Address - Country:US
Practice Address - Phone:443-262-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23600101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD185035100Medicaid