Provider Demographics
NPI:1225364888
Name:PALAZUELOS- DONIGAN, KATHLEEN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PALAZUELOS- DONIGAN
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 1:22655 WASHINGTON ST
Mailing Address - Street 2:P.O. BOX 1213
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3848
Mailing Address - Country:US
Mailing Address - Phone:240-431-1151
Mailing Address - Fax:
Practice Address - Street 1:22655 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3848
Practice Address - Country:US
Practice Address - Phone:240-431-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561800Medicaid