Provider Demographics
NPI:1104254069
Name:SCHROEDER, KELLY (LCSW-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 HARFORD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2643
Mailing Address - Country:US
Mailing Address - Phone:410-877-7207
Mailing Address - Fax:410-877-7224
Practice Address - Street 1:1716 HARFORD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2643
Practice Address - Country:US
Practice Address - Phone:410-877-7207
Practice Address - Fax:410-877-7224
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health