Provider Demographics
NPI:1609330489
Name:KELLY, ERICA DANYELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DANYELLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9887 EDISTO WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1801
Mailing Address - Country:US
Mailing Address - Phone:443-762-7537
Mailing Address - Fax:
Practice Address - Street 1:9887 EDISTO WAY
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-1801
Practice Address - Country:US
Practice Address - Phone:443-762-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0000Medicaid
0000OtherNPI