Provider Demographics
NPI:1336785401
Name:DICARLANTONIO, KELLY L (MED, LCMHC NCC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:L
Last Name:DICARLANTONIO
Suffix:
Gender:F
Credentials:MED, LCMHC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9807 GABLE RIDGE TER APT E
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4669
Mailing Address - Country:US
Mailing Address - Phone:301-467-0682
Mailing Address - Fax:
Practice Address - Street 1:53 E PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5673
Practice Address - Country:US
Practice Address - Phone:704-912-4095
Practice Address - Fax:704-943-0512
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA151100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty