Provider Demographics
NPI:1508564345
Name:KENNELL-GAITHER, KATELYN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:
Last Name:KENNELL-GAITHER
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 1:12502 WILLOWBROOK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6498
Mailing Address - Country:US
Mailing Address - Phone:240-964-8793
Mailing Address - Fax:240-964-8679
Practice Address - Street 1:12502 WILLOWBROOK RD STE 380
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6592
Practice Address - Country:US
Practice Address - Phone:240-964-8793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker