Provider Demographics
NPI:1447344346
Name:KELLY, SHARON MICHELE (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MICHELE
Last Name:KELLY
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 1:7610 PERRING TER
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6121
Mailing Address - Country:US
Mailing Address - Phone:410-605-7365
Mailing Address - Fax:
Practice Address - Street 1:5906 PARK HEIGHTS AVE
Practice Address - Street 2:SUITE 107-12
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3631
Practice Address - Country:US
Practice Address - Phone:410-236-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD146031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical