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General NPI Number Information
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NPI Number | 1457096059
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Entity Type | Individual
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Provider Name | KELLEY MATTINGLY LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 11100 BILLINGSLEY RD
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City | WALDORF
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State | MD
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Zip | 20602-3400
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Country | US
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Telephone | 610-994-2968
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 RENAISSANCE BLVD FL 4
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2781
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Country | US
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Telephone | 610-994-2968
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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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