Healthcare Provider Details

I. General information

NPI: 1942456587
Provider Name (Legal Business Name): KELLY ANNE GILL LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 TWINBROOK PKWY
ROCKVILLE MD
20851-1400
US

IV. Provider business mailing address

751 TWINBROOK PKWY
ROCKVILLE MD
20851-1400
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-4100
  • Fax: 301-315-8331
Mailing address:
  • Phone: 301-838-4100
  • Fax: 301-315-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14281
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: