Provider Demographics
NPI:1558376400
Name:LARGER, KATHEY JEAN (LCSWC, LCPC)
Entity Type:Individual
Prefix:
First Name:KATHEY
Middle Name:JEAN
Last Name:LARGER
Suffix:
Gender:F
Credentials:LCSWC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 RIVERSIDE DR
Mailing Address - Street 2:STE A
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5369
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:1113 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4470
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:410-334-6362
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD346646OtherMANAGED HEALTH NETWORK
MD609550001Medicaid
MD609550004Medicaid
MD517251OtherUNITED BEHAVIORAL HEALTH
MD499188OtherVO-MHA
MDLM49EAOtherCAREFIRST BCBS
MD522156095OtherTRICARE
MD609550002Medicaid
MD522156095OtherTRICARE