Provider Demographics
NPI:1376237560
Name:WATKINS, KELLY CAMARA
Entity Type:Individual
Prefix:
First Name:KELLY CAMARA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAMARA
Other - Middle Name:
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4510 WOODBERRY ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1064
Mailing Address - Country:US
Mailing Address - Phone:646-825-0862
Mailing Address - Fax:
Practice Address - Street 1:845 QUINCE ORCHARD BLVD STE F
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1676
Practice Address - Country:US
Practice Address - Phone:301-769-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041C0700X, 104100000X
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker