Provider Demographics
NPI:1578655536
Name:MCCABE, KATHLEEN ELIZABETH (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:MCCABE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 REGESTER AVE
Mailing Address - Street 2:
Mailing Address - City:IDLEWYLDE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1614
Mailing Address - Country:US
Mailing Address - Phone:301-922-2743
Mailing Address - Fax:
Practice Address - Street 1:200 E JOPPA RD STE 203
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3107
Practice Address - Country:US
Practice Address - Phone:301-922-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0803101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216102800Medicaid
182990OtherCOMPSYCH
RS830010OtherCAREFIRST GHMSI
60875801OtherCAREFIRST MD