Provider Demographics
NPI:1265268916
Name:GARDINER, KELLY ELIZABETH (LCSW-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ELIZABETH
Last Name:GARDINER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:GARDINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:1716 HARFORD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2699
Mailing Address - Country:US
Mailing Address - Phone:410-877-7207
Mailing Address - Fax:410-877-7224
Practice Address - Street 1:1716 HARFORD RD STE 204
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2699
Practice Address - Country:US
Practice Address - Phone:410-877-7207
Practice Address - Fax:410-877-7224
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD278981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical