Provider Demographics
NPI:1457000564
Name:PREST, KATHLEEN (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PREST
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 1:18218 ROY CROFT DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1682
Mailing Address - Country:US
Mailing Address - Phone:570-606-5293
Mailing Address - Fax:
Practice Address - Street 1:18218 ROY CROFT DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-1682
Practice Address - Country:US
Practice Address - Phone:570-606-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27920104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker