Basic Information
| Provider Information | |||||||||
| NPI: | 1558376400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARGER | ||||||||
| FirstName: | KATHEY | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | LCSWC, LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 547 RIVERSIDE DR | ||||||||
| Address2: | STE A | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346961 | ||||||||
| FaxNumber: | 4103346362 | ||||||||
| Practice Location | |||||||||
| Address1: | 1113 HEALTHWAY DR | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218044470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346961 | ||||||||
| FaxNumber: | 4103346362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 12992 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 346646 | 01 | MD | MANAGED HEALTH NETWORK | OTHER | 609550001 | 05 | MD | MEDICAID | 609550004 | 05 | MD | MEDICAID | 517251 | 01 | MD | UNITED BEHAVIORAL HEALTH | OTHER | 499188 | 01 | MD | VO-MHA | OTHER | LM49EA | 01 | MD | CAREFIRST BCBS | OTHER | 522156095 | 01 | MD | TRICARE | OTHER | 609550002 | 05 | MD | MEDICAID |