Provider Demographics
NPI:1346473105
Name:BARSELLA, KIM NICOLE (MSW, LCSW-C, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:NICOLE
Last Name:BARSELLA
Suffix:
Gender:F
Credentials:MSW, LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12802 BROADMORE ROAD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3111
Mailing Address - Country:US
Mailing Address - Phone:301-272-5738
Mailing Address - Fax:301-760-7651
Practice Address - Street 1:2027 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5918
Practice Address - Country:US
Practice Address - Phone:301-272-5738
Practice Address - Fax:301-760-7651
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107931041C0700X
DCLC3030191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical