Provider Demographics
NPI:1154681161
Name:AGUIRRE, KELLY ANN (MSW, MPH, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:MSW, MPH, LICSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:HAINES
Other - Last Name:AGUIRRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, MPH, LICSW
Mailing Address - Street 1:2001 S ST NW STE 310
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1164
Mailing Address - Country:US
Mailing Address - Phone:678-995-3559
Mailing Address - Fax:
Practice Address - Street 1:2000 P ST NW STE 505
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6921
Practice Address - Country:US
Practice Address - Phone:678-995-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500793741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical