Provider Demographics
NPI:1912753195
Name:HAGUE, KELLY A (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:HAGUE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BURTON ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-1607
Mailing Address - Country:US
Mailing Address - Phone:302-236-9480
Mailing Address - Fax:
Practice Address - Street 1:7549 WILKINS RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-4106
Practice Address - Country:US
Practice Address - Phone:302-422-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ3-0011052104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker