Provider Demographics
NPI:1790067221
Name:KATHERMAN, JOANNA ROSE (LGSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:ROSE
Last Name:KATHERMAN
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 N LAKE RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-3444
Mailing Address - Country:US
Mailing Address - Phone:570-419-0892
Mailing Address - Fax:
Practice Address - Street 1:606 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1341
Practice Address - Country:US
Practice Address - Phone:410-479-3800
Practice Address - Fax:410-479-0052
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker