Provider Demographics
NPI:1720490733
Name:KEICHER, KARA MARIE (LCSW-C, LMT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:KEICHER
Suffix:
Gender:F
Credentials:LCSW-C, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2531
Mailing Address - Country:US
Mailing Address - Phone:305-992-7994
Mailing Address - Fax:
Practice Address - Street 1:656 E 37TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2531
Practice Address - Country:US
Practice Address - Phone:305-992-7994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-25
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM02048225700000X
MD243071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD383841200Medicaid