Provider Demographics
NPI:1922772417
Name:MORAN, KATHY D (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:D
Last Name:MORAN
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 1:7407 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7928
Mailing Address - Country:US
Mailing Address - Phone:443-691-4131
Mailing Address - Fax:
Practice Address - Street 1:4800 ROLAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2347
Practice Address - Country:US
Practice Address - Phone:443-691-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical