Provider Demographics
NPI:1467736546
Name:CORNELL, KATHERINE HADLEY (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HADLEY
Last Name:CORNELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 YORK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3048
Mailing Address - Country:US
Mailing Address - Phone:410-949-5533
Mailing Address - Fax:410-617-1203
Practice Address - Street 1:1014 W 36TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2415
Practice Address - Country:US
Practice Address - Phone:410-949-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04915103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical