Individual provider Active NPI

Jada Kelly, LMSW

  • School Social Worker
  • Landover, MD
National Provider Identifier
1336965367
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Social WorkerTaxonomy code 1041S0200X
License
30160 Issued in MD
Practice address
8181 Professional PL Ste 200
Landover, MD 20785-7219
Phone
(301) 306-4590
Fax
(301) 880-0054
NPI assigned
Nov 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Social Worker 1041S0200X 30160 MD Primary

Addresses

Primary practice location

8181 Professional PL Ste 200
Landover, MD 20785-7219

Mailing address

8181 Professional PL Ste 200
Landover, MD 20785-7219
Phone (301) 306-4590

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
30160MDMDSchool Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Interdynamics, Inc. CurrentSince Dec 1, 2024 Accepting new patients
Interdynamics, Inc. PastSince Dec 1, 2024 Accepting new patients

Locations

8181 Professional Pl
Ste 200
Landover, MD 20785
Phone (301) 306-4590

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1336965367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8181 PROFESSIONAL PL STE 200",
            "city": "LANDOVER",
            "state": "MD",
            "postal_code": "207857219",
            "telephone_number": "301-306-4590",
            "fax_number": "301-880-0054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8181 PROFESSIONAL PL STE 200",
            "city": "LANDOVER",
            "state": "MD",
            "postal_code": "207857219",
            "telephone_number": "301-306-4590",
            "fax_number": "301-880-0054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JADA",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-25",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "MD",
            "license": "30160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Landover, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; 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.