Individual provider Active NPI

Katie Lynn Maldonado, LCSW-C

  • Clinical Social Worker
  • Berlin, MD
National Provider Identifier
1689349524
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
27214 Issued in MD
Practice address
9958 N Main St
Berlin, MD 21811-1076
Phone
(410) 973-2820
Fax
(410) 973-2843
NPI assigned
Aug 12, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 27214 MD Primary

Addresses

Primary practice location

9958 N Main St
Berlin, MD 21811-1076

Mailing address

PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015

Other identifiers 1

IdentifierTypeStateIssuer
119591300MedicaidMD

Other names 1

  • Ms. Katie Lynn Fox Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240618003220 MD Practitioner - Clinical Social Worker 0648713602 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Three Lower Counties Community Services, Inc. CurrentSince May 22, 2024 Accepting new patients
Three Lower Counties Community Services Inc Current Accepting new patients
Evolve Mental Wellness Clinical CurrentSince Sep 1, 2025 Accepting new patients
Three Lower Counties Community Services, Inc. CurrentSince May 22, 2024 Accepting new patients

Locations

9956 N Main St
Unit 2
Berlin, MD 21811
Phone (410) 641-9568

9958 N Main St
Berlin, MD 21811
Phone (410) 973-2820

12137 Elm St
Princess Anne, MD 21853
Phone (410) 651-1000

1411 Wesley Dr
Salisbury, MD 21801
Phone (410) 642-4011

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1689349524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1978",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218021978",
            "telephone_number": "410-749-1015",
            "fax_number": "410-749-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9958 N MAIN ST",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111076",
            "telephone_number": "410-973-2820",
            "fax_number": "410-973-2843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "KATIE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-12",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "27214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119591300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "FOX",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Berlin, MD

Sources for this page

Verify at the official NPI Registry.