Provider Demographics
NPI:1205047388
Name:KOEHLER, MEGHAN (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:
Last Name:KOEHLER
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 1:210 WOODHILL DR
Mailing Address - Street 2:APT E
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5745
Mailing Address - Country:US
Mailing Address - Phone:443-995-0102
Mailing Address - Fax:
Practice Address - Street 1:10123 SENATE DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4367
Practice Address - Country:US
Practice Address - Phone:301-459-9840
Practice Address - Fax:301-459-4856
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11398Medicaid
MD11398Medicaid