Provider Demographics
NPI:1174537112
Name:HOSPELHORN, KERRY LYNN (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:LYNN
Last Name:HOSPELHORN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ABELIA RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1755
Mailing Address - Country:US
Mailing Address - Phone:410-428-2191
Mailing Address - Fax:
Practice Address - Street 1:1700 ABELIA RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-1755
Practice Address - Country:US
Practice Address - Phone:410-428-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD383050100Medicaid
MDT046Medicare UPIN
MD452839Medicare UPIN
MDQF54-KLMedicare UPIN