Kelly Bragg, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC6441 Issued in MD

Practice address

626 Revolution St
Havre de Grace, MD 21078-3320

Phone

(410) 939-8744

NPI assigned

May 22, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1184036360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783320",
            "telephone_number": "410-939-8744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "336 S Main St Ste 1D",
            "address_purpose": "LOCATION",
            "city": "Bel Air",
            "state": "MD",
            "postal_code": "210143978",
            "country_code": "US",
            "telephone_number": "443-987-6818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRAGG",
        "first_name": "KELLY",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-22",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC6441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisabeth Bolt
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• Sakeena Jentae Bowman, COTA/L
• Debbie L Boyd, CRNP
• John S Braxton III, P.A.
• Brenda Jaffe, LCSW-C, LLC
• Brian C. de Muth M.D., PA
• Brian C. de Muth, M.D., PA
• Jessica Tierra Bridges

• Professional Counselor in Havre de Grace, MD
• Providers in Havre de Grace, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.