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General NPI Number Information
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NPI Number | 1265640692
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Entity Type | Individual
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Provider Name | MAURINE KELBER KELLY PHD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4809 ST ELMO AVENUE
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City | BETHESDA
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State | MD
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Zip | 20814-3009
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Country | US
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Telephone | 301-649-1896
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Fax | 301-649-1843
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Provider Business Mailing Address
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Address Line | 11621 YEATMAN TERRACE
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City | SILVER SPRING
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State | MD
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Zip | 20902-3057
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Country | US
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Telephone | 301-649-1896
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Fax | 301-649-1843
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1331
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1507
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License Number State | DC
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