Healthcare Provider Details

I. General information

NPI: 1619521333
Provider Name (Legal Business Name): KELLY VAHEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 MCCORMICK RD # LL10
HUNT VALLEY MD
21031-1002
US

IV. Provider business mailing address

8 MIDDLE WOODS CT
PARKTON MD
21120-8915
US

V. Phone/Fax

Practice location:
  • Phone: 410-494-0085
  • Fax:
Mailing address:
  • Phone: 410-494-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: KELLY VAHEY
Title or Position: PROVIDER
Credential: LCSW-C
Phone: 410-494-0085