Provider Demographics
NPI:1770011744
Name:KELLEY, STEPHANIE LIANEE (LGSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LIANEE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 CALHOUN PL
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21885
Mailing Address - Country:US
Mailing Address - Phone:240-777-4444
Mailing Address - Fax:
Practice Address - Street 1:7300 CALHOUN PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2790
Practice Address - Country:US
Practice Address - Phone:240-777-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD223381041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical