Provider Demographics
NPI:1679464184
Name:BOUMADI, KAOUTAR
Entity type:Individual
Prefix:
First Name:KAOUTAR
Middle Name:
Last Name:BOUMADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4837 BUSHEY RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9412
Mailing Address - Country:US
Mailing Address - Phone:443-609-2165
Mailing Address - Fax:
Practice Address - Street 1:541 SUSQUEHANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-2784
Practice Address - Country:US
Practice Address - Phone:443-609-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27187104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker