Provider Demographics
NPI:1982794319
Name:HIBBARD, STEPHANIE KATHERINE (LCSWC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KATHERINE
Last Name:HIBBARD
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:KATHERINE
Other - Last Name:MCBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWC
Mailing Address - Street 1:1331 KINLOCH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012
Mailing Address - Country:US
Mailing Address - Phone:410-647-8210
Mailing Address - Fax:410-647-8267
Practice Address - Street 1:507 WEST DRIVE
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-647-8210
Practice Address - Fax:410-647-8267
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13249104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015178500Medicaid