Provider Demographics
NPI:1598801490
Name:KIJEWSKI, LAURA (BSW, LSWA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:KIJEWSKI
Suffix:
Gender:F
Credentials:BSW, LSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 LUBBOCK LN
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-3653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2670 CRAIN HWY
Practice Address - Street 2:SUITE 402
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2806
Practice Address - Country:US
Practice Address - Phone:301-396-4105
Practice Address - Fax:301-396-5733
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA04832104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker