Kim Bennett-Selby, LCSW-C
Individual provider Active NPI Clinical Social Worker · Edgewood, MD
NPI 1194026211 · NPPES record last updated Jun 12, 2012
Key facts
- NPI
- 1194026211
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 09184 (MD)
- Practice address
- 1331 Charlestown Dr
Edgewood, MD 21040-2204 - Phone
- (443) 928-9554
- NPI assigned
- Nov 4, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09184 | MD | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 09184 | MD | Yes |
Addresses
Primary practice location
1331 Charlestown Dr
Edgewood, MD 21040-2204
Mailing address
1331 Charlestown Dr
Edgewood, MD 21040-2204
Phone (443) 928-9554
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 052507300 | Medicaid | MD |
Other providers in Edgewood, MD
- Hilda Tifu Azong
- Kionna Barnes
- Jennifer Tracy Bartlebaugh
- Behavioral Health Connections
- Christina Benboudiaf
- Cecilia Lariba Bibio
- Amanda Louise Boblitz-McFadden
- Emily Boyd
- Patrice Merle Boykin
- Bright House Counseling and Coaching LLC
All providers in Edgewood, MD · Clinical Social Worker in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.