Basic Information
| Provider Information | |||||||||
| NPI: | 1720490733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEICHER | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LMSW, LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 FALLSWAY | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212024800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437031294 | ||||||||
| FaxNumber: | 4108378020 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 FALLSWAY | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437031294 | ||||||||
| FaxNumber: | 4108378020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2014 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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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 | 104100000X | 24307 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | 225700000X | M02048 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | 383841200 | 05 | MD | MEDICAID |