MEDICARE: KELLY-ANN M JAMES-HAYNES LMSW-20069

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	LMSW20069	MD

General Provider Information

NPI Number	:	1871288761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY-ANN M JAMES-HAYNES LMSW-20069

Provider Business Mailing Address
First Line	:	1910 TOWNE CENTRE BLVD STE 300
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3598
Country	:	US
Telephone Number	:	443-646-3907
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 TOWNE CENTRE BLVD STE 300
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3598
Country	:	US
Telephone Number	:	443-646-3907
Fax Number	:

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

Provider Enumeration Date	:	04/07/2023
Last Update Date	:	04/07/2023

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