Provider Demographics
NPI:1801993498
Name:CREGAN, KELLY MARIE (LCSW-C)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:MARIE
Last Name:CREGAN
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 1:8737 COLESVILLE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3928
Mailing Address - Country:US
Mailing Address - Phone:301-562-1952
Mailing Address - Fax:301-562-1953
Practice Address - Street 1:8737 COLESVILLE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3928
Practice Address - Country:US
Practice Address - Phone:301-562-1952
Practice Address - Fax:301-562-1953
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical