Provider Demographics
NPI:1366781429
Name:KELLY, AUDREY MICHELLE (MSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:MICHELLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WYNDHURST AVE STE 307A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2419
Mailing Address - Country:US
Mailing Address - Phone:410-216-4817
Mailing Address - Fax:
Practice Address - Street 1:600 WYNDHURST AVE STE 307A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2419
Practice Address - Country:US
Practice Address - Phone:410-216-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-10
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD224441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical