Provider Demographics
NPI:1649597873
Name:HUKMANI, KELLY E (LCSW-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:HUKMANI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10451 TWIN RIVERS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2332
Mailing Address - Country:US
Mailing Address - Phone:410-366-1980
Mailing Address - Fax:410-366-8530
Practice Address - Street 1:10451 TWIN RIVERS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2388
Practice Address - Country:US
Practice Address - Phone:410-997-3557
Practice Address - Fax:410-964-1791
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
238486OtherJHHC
294213OtherKAISER PERMANENTE
MD031318100Medicaid
100143783OtherAPS HEALTHCARE
MD966369-01OtherCAREFIRST (MD #)
MDT541-0112OtherCAREFIRST
100143783OtherAPS HEALTHCARE