Provider Demographics
NPI:1497237978
Name:ODOHERTY, KATHERINE BACHER (LCPAT, ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BACHER
Last Name:ODOHERTY
Suffix:
Gender:F
Credentials:LCPAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 BELLONA AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-1957
Mailing Address - Country:US
Mailing Address - Phone:443-480-9783
Mailing Address - Fax:
Practice Address - Street 1:101 W RIDGELY RD BLDG SUITE8B
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5101
Practice Address - Country:US
Practice Address - Phone:443-480-9783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health