Provider Demographics
NPI:1841901063
Name:RAO, KAVITHA B (PHD)
Entity type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:B
Last Name:RAO
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 LOCH RAVEL BOULEVARD
Mailing Address - Street 2:SMYTH BUILDING SUITE 404
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239
Mailing Address - Country:US
Mailing Address - Phone:202-877-1120
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BOULEVARD
Practice Address - Street 2:SMYTH BUILDING SUITE 404
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239
Practice Address - Country:US
Practice Address - Phone:202-877-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007725103TC0700X
MD06864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical