Provider Demographics
NPI:1821234956
Name:KANE, MARY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:ROOM D225
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3464
Mailing Address - Fax:410-938-5131
Practice Address - Street 1:10085 RED RUN BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4836
Practice Address - Country:US
Practice Address - Phone:410-581-7804
Practice Address - Fax:410-356-6507
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD224621041C0700X
NJ44SC05446400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245836Medicaid
NY35446 A & BOtherMEDICARE