Provider Demographics
NPI:1760921241
Name:TRAVERSARI, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:TRAVERSARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:HESTERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 HELFEN BEIN LN STE 230A
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2667
Mailing Address - Country:US
Mailing Address - Phone:410-622-3202
Mailing Address - Fax:410-820-5884
Practice Address - Street 1:100 HELFEN BEIN LN STE 230A
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2667
Practice Address - Country:US
Practice Address - Phone:410-622-3202
Practice Address - Fax:410-820-5884
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD205951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical