Provider Demographics
NPI:1770516858
Name:IMIRIE, KATHRYN BURKE (LCSWC)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:BURKE
Last Name:IMIRIE
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JEAN
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17041 BULLFROG RD
Mailing Address - Street 2:
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-8732
Mailing Address - Country:US
Mailing Address - Phone:301-471-2585
Mailing Address - Fax:
Practice Address - Street 1:10926 SIMMONS RD
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-8400
Practice Address - Country:US
Practice Address - Phone:301-471-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD098661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD698800800Medicaid
MD698800800Medicaid