Provider Demographics
NPI:1447971247
Name:KELLEY, ANGELA MARIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:KELLEY
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 1:5005 GRINDON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2138
Mailing Address - Country:US
Mailing Address - Phone:410-456-6372
Mailing Address - Fax:
Practice Address - Street 1:5820 YORK RD STE 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3620
Practice Address - Country:US
Practice Address - Phone:301-345-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD290411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical