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NPI Code Detail

MEDICARE: AMY KELLY

MEDICARE: AMY KELLY
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
11041S0200XSchool Social Worker15731MD

General Provider Information

NPI Number : 1407791171
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY KELLY
Provider Business Mailing Address
First Line : 10910 CLARKSVILLE PIKE
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21042-6106
Country : US
Telephone Number : 667-257-7296
Fax Number :
Provider Business Practice Location Address
First Line : 10910 CLARKSVILLE PIKE
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21042-6106
Country : US
Telephone Number : 667-257-7296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2026
Last Update Date : 04/22/2026

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