MEDICARE: ALEXSYS KELLAWAY-MCCLUSKY

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	34396	MD

General Provider Information

NPI Number	:	1447107362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXSYS KELLAWAY-MCCLUSKY

Provider Business Mailing Address
First Line	:	7846 WOODSIDE TER APT 201
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5183
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 HOLABIRD AVE
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-1788
Country	:	US
Telephone Number	:	810-428-5057
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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