Healthcare Provider Details

I. General information

NPI: 1700934007
Provider Name (Legal Business Name): KELLY MICHELLE VAHEY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E JOPPA RD SUITE 402
TOWSON MD
21286-3150
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: 410-664-0683
Mailing address:
  • Phone: 410-494-0085
  • Fax: 410-357-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11308
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier578063000
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerMAGELLAN MIS #
# 2
Identifier620491-03
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST MD RENDERING #
# 3
IdentifierQH98KM
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST MD PROVIDER #
# 4
IdentifierW945-0001
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST GHMSI
# 5
Identifier401845100
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: