Basic Information
| Provider Information | |||||||||
| NPI: | 1215151964 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2336 GODDARD PKWY | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218011126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346961 | ||||||||
| FaxNumber: | 4103346362 | ||||||||
| Practice Location | |||||||||
| Address1: | 11120 SOMERSET AVE | ||||||||
| Address2: | |||||||||
| City: | PRINCESS ANNE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218532970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106514200 | ||||||||
| FaxNumber: | 4106514290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 08/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 13691 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 522156095 | 01 | MD | APS | OTHER | LM49EA | 01 | MD | CAREFIRST BCBS OF MARYLAND | OTHER | 522156095 | 01 | MD | CIGNA BEHAVIORAL HEALTH | OTHER | 522156095 | 01 | MD | MHNET BEHAVIORAL HEALTH | OTHER | R968 | 01 | MD | CAREFIRST | OTHER | 346646 | 01 | MD | MHN | OTHER | 522156095 | 01 | MD | UBH | OTHER | 600478097 | 01 | MD | MAGELLAN BEHAVIORAL HEALTH | OTHER | 609550001 | 05 | MD | MEDICAID | 609550004 | 05 | MD | MEDICAID | 9772653 | 01 | MD | AETNA | OTHER |