Provider Demographics
NPI:1780897397
Name:TRAVERS, KATHERINE ANNE (MSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7129 STATION HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6837
Mailing Address - Country:US
Mailing Address - Phone:443-562-6955
Mailing Address - Fax:
Practice Address - Street 1:7050 OAKLAND MILLS RD
Practice Address - Street 2:SUITE 140
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2193
Practice Address - Country:US
Practice Address - Phone:443-325-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD117851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401650501Medicaid