Provider Demographics
NPI:1700934007
Name:VAHEY, KELLY MICHELLE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MICHELLE
Last Name:VAHEY
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 1:8 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:410-357-5640
Practice Address - Street 1:200 E JOPPA RD
Practice Address - Street 2:SUITE 402
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3150
Practice Address - Country:US
Practice Address - Phone:410-494-0085
Practice Address - Fax:410-664-0683
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD578063000OtherMAGELLAN MIS #
MD620491-03OtherCAREFIRST MD RENDERING #
MDQH98KMOtherCAREFIRST MD PROVIDER #
MDW945-0001OtherCAREFIRST GHMSI
MD401845100Medicaid
MA1700934007Medicare UPIN