Provider Demographics
NPI:1639552391
Name:COONEY, KATHY (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:COONEY
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 1:513 HANNA RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5375
Mailing Address - Country:US
Mailing Address - Phone:410-420-2696
Mailing Address - Fax:410-529-1342
Practice Address - Street 1:8615 RIDGELYS CHOICE DR
Practice Address - Street 2:SUITE 212
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-3026
Practice Address - Country:US
Practice Address - Phone:410-529-2151
Practice Address - Fax:410-529-1342
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional