Provider Demographics
NPI:1447896014
Name:KERSEVICH, SONIA ELIZABETH (LCSW-C)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:ELIZABETH
Last Name:KERSEVICH
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 1:5258 WYNDHOLME CIR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3202
Mailing Address - Country:US
Mailing Address - Phone:240-390-5663
Mailing Address - Fax:
Practice Address - Street 1:5720 EXECUTIVE DR STE 102
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1757
Practice Address - Country:US
Practice Address - Phone:410-762-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD213811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical