Provider Demographics
NPI:1295870533
Name:SANNER, KATHLEEN MARY (LCSW C)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:SANNER
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2016 FRIZZELLBURY RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158
Mailing Address - Country:US
Mailing Address - Phone:410-848-8549
Mailing Address - Fax:
Practice Address - Street 1:5560 STERRETT PLACE
Practice Address - Street 2:STE 201
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-995-5555
Practice Address - Fax:410-995-5556
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH1240001OtherCAREFIRST BCBS
MD268919OtherMD IPA ALLIANCE
182178OtherMANAGED HEALTH NETWORK
226159OtherKAISER PERMANENTE
MD268919OtherMAMSI OPTIMUM CHOICE
9096617OtherPRIVATE HEALTHCARE SYSTEM
4619006OtherAETNA US HEALTHCARE
015113OtherVALUE OPTIONS
MD52752905OtherCAREFIRST BCBS
PVPB92545OtherAMERICAN PSYCH SYSTEMS
MD52752905OtherCAREFIRST BCBS