Healthcare Provider Details

I. General information

NPI: 1447971247
Provider Name (Legal Business Name): ANGELA MARIE KELLEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD STE 202
BALTIMORE MD
21212-3620
US

IV. Provider business mailing address

5005 GRINDON AVE
BALTIMORE MD
21214-2138
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax:
Mailing address:
  • Phone: 410-456-6372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29041
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: