Provider Demographics
NPI:1235245044
Name:HAWKINS, KELLY ANN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:HAWKINS
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 1:2336 GODDARD PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1126
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:11120 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2970
Practice Address - Country:US
Practice Address - Phone:410-651-4200
Practice Address - Fax:410-651-4290
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MD9179835OtherAETNA
MDR968OtherCAREFIRST FEDERAL
MD600645538OtherMAGELLAN BEHAVIORAL HEALTH
MD609550001Medicaid
MD609550004Medicaid
MD464301OtherMANAGED HEALTH NETWORK (MHN)
MDLM49EAOtherCAREFIRST BCBS
MD176282ZAJJMedicare PIN
742LMedicare PIN