Healthcare Provider Details

I. General information

NPI: 1649597873
Provider Name (Legal Business Name): KELLY E HUKMANI LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10451 TWIN RIVERS RD SUITE 100
COLUMBIA MD
21044-2388
US

IV. Provider business mailing address

10451 TWIN RIVERS RD STE 100
COLUMBIA MD
21044-2332
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-3557
  • Fax: 410-964-1791
Mailing address:
  • Phone: 410-366-1980
  • Fax: 410-366-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13023
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: