Provider Demographics
NPI:1235915414
Name:TRIMBLE, KELLY (LCSWC, LICSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:LCSWC, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 PLAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6152
Mailing Address - Country:US
Mailing Address - Phone:302-893-9930
Mailing Address - Fax:
Practice Address - Street 1:8041 CONNECTICUT AVE
Practice Address - Street 2:SUITE 1120
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-593-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD297291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty