Healthcare Provider Details

I. General information

NPI: 1376237560
Provider Name (Legal Business Name): KELLY CAMARA WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMARA WATKINS

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 QUINCE ORCHARD BLVD STE F
GAITHERSBURG MD
20878-1676
US

IV. Provider business mailing address

4510 WOODBERRY ST
RIVERDALE MD
20737-1064
US

V. Phone/Fax

Practice location:
  • Phone: 301-769-5878
  • Fax:
Mailing address:
  • Phone: 646-825-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: