Provider Demographics
NPI:1457493579
Name:BLAKESLEE, KATHARINE (LCSWC)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:BLAKESLEE
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:GUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWC
Mailing Address - Street 1:7801 YORK RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7446
Mailing Address - Country:US
Mailing Address - Phone:410-337-7772
Mailing Address - Fax:410-337-8729
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE 215
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:410-337-7772
Practice Address - Fax:410-337-8729
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD079831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQY46OtherPROVIDER NUMBER
MDQY46OtherPROVIDER NUMBER