Provider Demographics
NPI:1255376695
Name:MADINA, KAMIL SUDAN (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:KAMIL
Middle Name:SUDAN
Last Name:MADINA
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2631 GUILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4613
Mailing Address - Country:US
Mailing Address - Phone:410-366-8653
Mailing Address - Fax:410-576-9257
Practice Address - Street 1:201 N CHARLES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4102
Practice Address - Country:US
Practice Address - Phone:410-576-9191
Practice Address - Fax:410-576-9257
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD099211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical