MEDICARE: MS. MARY MAE KELLY L.M.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801091372	MI
2	104100000X	Social Worker	6801091372	MI

General Provider Information

NPI Number	:	1174953095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY MAE KELLY L.M.S.W.

Provider Business Mailing Address
First Line	:	1513 COLUMBUS AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-6824
Country	:	US
Telephone Number	:	989-930-7527
Fax Number	:	989-930-7527

Provider Business Practice Location Address
First Line	:	1513 COLUMBUS AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-6824
Country	:	US
Telephone Number	:	989-930-7527
Fax Number	:	989-778-2700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	12/18/2025

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