Provider Demographics
NPI:1902922339
Name:NEEL, KATHRYN LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LOUISE
Last Name:NEEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1525
Mailing Address - Country:US
Mailing Address - Phone:410-730-8877
Mailing Address - Fax:410-730-8877
Practice Address - Street 1:10796 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3646
Practice Address - Country:US
Practice Address - Phone:410-730-8877
Practice Address - Fax:410-997-0396
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3664103TC0700X, 103TC2200X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD230P504GMedicare ID - Type UnspecifiedMEDICARE