Provider Demographics
NPI:1477903714
Name:MAHER, KELLY MICHELE (LCPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELE
Last Name:MAHER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S DUNDALK AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4273
Mailing Address - Country:US
Mailing Address - Phone:410-220-0720
Mailing Address - Fax:410-862-0150
Practice Address - Street 1:40 S DUNDALK AVE STE 400
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-4273
Practice Address - Country:US
Practice Address - Phone:410-220-0720
Practice Address - Fax:410-862-0150
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD504204600Medicaid