Provider Demographics
NPI:1427757582
Name:KELLY, STEPHANIE MICHELE (LMSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 ANGEL CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1033
Mailing Address - Country:US
Mailing Address - Phone:321-292-9504
Mailing Address - Fax:
Practice Address - Street 1:1712 ANGEL CT
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1033
Practice Address - Country:US
Practice Address - Phone:321-292-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29088104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker