MEDICARE: SUSAN KELLY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34661	MD
2	1041C0700X	Clinical Social Worker	CW025422	PA
3	1041C0700X	Clinical Social Worker	128353	MA

General Provider Information

NPI Number	:	1154081859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KELLY LCSW

Provider Business Mailing Address
First Line	:	7140 WINTER ROSE PATH
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7140 WINTER ROSE PATH
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5132
Country	:	US
Telephone Number	:	401-537-8877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2021
Last Update Date	:	06/15/2026

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Directions to “ SUSAN KELLY LCSW” Practice Location

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