Provider Demographics
NPI:1619521333
Name:KELLY VAHEY LLC
Entity Type:Organization
Organization Name:KELLY VAHEY LLC
Other - Org Name:KELLY VAHEY, LCSW-C
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-494-0085
Mailing Address - Street 1:8 MIDDLE WOODS CT
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-8915
Mailing Address - Country:US
Mailing Address - Phone:410-494-0085
Mailing Address - Fax:
Practice Address - Street 1:11350 MCCORMICK RD # LL10
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1002
Practice Address - Country:US
Practice Address - Phone:410-494-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization