Provider Demographics
NPI:1265905277
Name:LORD, KATRINA GOLIBER (MSW)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:GOLIBER
Last Name:LORD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 OLD FENCE RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2440
Mailing Address - Country:US
Mailing Address - Phone:301-467-4523
Mailing Address - Fax:
Practice Address - Street 1:1401 DENNIS AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3827
Practice Address - Country:US
Practice Address - Phone:240-740-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG127481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical