Provider Demographics
NPI:1437161585
Name:WISSMAN, KATHERINE BLAIR (LSCW-C)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:BLAIR
Last Name:WISSMAN
Suffix:
Gender:F
Credentials:LSCW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6123 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4860
Mailing Address - Country:US
Mailing Address - Phone:301-838-4200
Mailing Address - Fax:301-309-2596
Practice Address - Street 1:6123 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-881-3700
Practice Address - Fax:301-468-1862
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12093104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403337000Medicaid
MD622642 01OtherBCBS OF MD
MD236676OtherKAISER
MD589530000OtherMAGELLAN
MD7134551OtherAETNA
DCA2840130OtherBCBS OF DC
MD236676OtherKAISER