Healthcare Provider Details

I. General information

NPI: 1184558249
Provider Name (Legal Business Name): NANCY CATHERINE KELLENBERGER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 LANDMARK DR STE 231
GLEN BURNIE MD
21061-4985
US

IV. Provider business mailing address

808 LANDMARK DR STE 231
GLEN BURNIE MD
21061-4985
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-2494
  • Fax: 667-600-4061
Mailing address:
  • Phone: 667-600-2494
  • Fax: 667-600-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12439
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: