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General NPI Number Information
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NPI Number | 1023833902
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Entity Type | Individual
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Provider Name | KELLY ELIZABETH MACDONNELL LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 4709 HARFORD RD STE 6
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City | BALTIMORE
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State | MD
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Zip | 21214-3205
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Country | US
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Telephone | 410-917-2992
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Fax |
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Provider Business Mailing Address
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Address Line | 9404 GOOD SPRING DR
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City | PERRY HALL
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State | MD
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Zip | 21128-9431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14657
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License Number State | MD
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