Provider Demographics
NPI:1467475921
Name:KERSCHBAUM, JOHN WILLIAM (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:KERSCHBAUM
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406B CRAIN HWY S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4099
Mailing Address - Country:US
Mailing Address - Phone:410-760-5588
Mailing Address - Fax:
Practice Address - Street 1:1406B CRAIN HWY S
Practice Address - Street 2:SUITE 301
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4099
Practice Address - Country:US
Practice Address - Phone:410-760-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18941041C0700X
MSCO4321041C0700X
MD158441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical