Provider Demographics
NPI:1740400928
Name:MCNULTY, KATHLEEN MARIE (LCSW C LICSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:LCSW C LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4938 HAMPDEN LANE
Mailing Address - Street 2:#199
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-717-1155
Mailing Address - Fax:301-654-4742
Practice Address - Street 1:4848 BATTERY LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-717-1155
Practice Address - Fax:301-654-4742
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107801041C0700X
DCLC3034691041C0700X
NY0497061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490972Medicare ID - Type Unspecified