Provider Demographics
NPI:1326700568
Name:DEMOSTHENE, KEDLYNE (LMSW)
Entity Type:Individual
Prefix:
First Name:KEDLYNE
Middle Name:
Last Name:DEMOSTHENE
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 1:1 LORING CT APT G
Mailing Address - Street 2:
Mailing Address - City:SPARROWS POINT
Mailing Address - State:MD
Mailing Address - Zip Code:21219-1426
Mailing Address - Country:US
Mailing Address - Phone:908-986-6369
Mailing Address - Fax:
Practice Address - Street 1:14 S BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1712
Practice Address - Country:US
Practice Address - Phone:410-276-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27903104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker