Kelly Boggiano, LCSW-C
Individual provider Active NPI Social Worker · Crofton, MD
NPI 1619533239 · NPPES record last updated Mar 10, 2020
Key facts
- NPI
- 1619533239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 22978 (MD)
- Practice address
- 2110 Priest Bridge Dr Ste 10
Crofton, MD 21114-2653 - Phone
- (443) 223-9014
- NPI assigned
- May 20, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 22978 | MD | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jill Joyce, MD PA | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 22978 | MD | Yes |
Addresses
Primary practice location
2110 Priest Bridge Dr Ste 10
Crofton, MD 21114-2653
Mailing address
434 McBride LN
Severna Park, MD 21146-2822
Other providers in Crofton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2020. 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.