Healthcare Provider Details

I. General information

NPI: 1952713455
Provider Name (Legal Business Name): KELLY KOLYER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 KANSAS LN
TAKOMA PARK MD
20912-4702
US

IV. Provider business mailing address

6451 KANSAS LN
TAKOMA PARK MD
20912-4702
US

V. Phone/Fax

Practice location:
  • Phone: 951-666-3387
  • Fax:
Mailing address:
  • Phone: 951-666-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18122
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: