Provider Demographics
NPI:1346982881
Name:KELLMAN, MOLLYE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MOLLYE
Middle Name:
Last Name:KELLMAN
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 1:101 W RIDGELY RD STE 8A
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5124
Mailing Address - Country:US
Mailing Address - Phone:443-367-1333
Mailing Address - Fax:
Practice Address - Street 1:101 W RIDGELY RD STE 8A
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5124
Practice Address - Country:US
Practice Address - Phone:443-367-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD249791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical