Provider Demographics
NPI:1780875591
Name:MCKITRICK, ENID L (LICSW)
Entity type:Individual
Prefix:
First Name:ENID
Middle Name:L
Last Name:MCKITRICK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 BOULDER RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5636
Mailing Address - Country:US
Mailing Address - Phone:202-429-9449
Mailing Address - Fax:
Practice Address - Street 1:8001 BOULDER RIDGE WAY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-5636
Practice Address - Country:US
Practice Address - Phone:202-429-9449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC30008241041C0700X
MD083091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0607OtherCAREFIRST
MD0607OtherCAREFIRST