Provider Demographics
NPI:1760697056
Name:KLOTZ, KATHALEEN M (MSW, LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KATHALEEN
Middle Name:M
Last Name:KLOTZ
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:3355 ST. JOHN'S LANE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:443-310-4980
Mailing Address - Fax:410-480-0110
Practice Address - Street 1:ST. JOHN'S STATION 3355 ST. JOHN'S LANE
Practice Address - Street 2:SUITE F
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:443-310-4980
Practice Address - Fax:410-480-0110
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical