Provider Demographics
NPI:1235805797
Name:STAPLES, KATHRYN E (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:STAPLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 OLD FORGE LN APT 4203
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2983
Mailing Address - Country:US
Mailing Address - Phone:410-919-3476
Mailing Address - Fax:
Practice Address - Street 1:1111 BENFIELD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-3004
Practice Address - Country:US
Practice Address - Phone:410-921-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26592104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker