Provider Demographics
NPI:1750897088
Name:DACUNHA, KELLY (MSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DACUNHA
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:VANDENHENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9114 OLD HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2659
Mailing Address - Country:US
Mailing Address - Phone:443-750-3477
Mailing Address - Fax:
Practice Address - Street 1:1300 YORK RD STE 200
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6090
Practice Address - Country:US
Practice Address - Phone:410-498-7624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical