Basic Information
| Provider Information | |||||||||
| NPI: | 1649597873 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUKMANI | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10451 TWIN RIVERS RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103661980 | ||||||||
| FaxNumber: | 4103668530 | ||||||||
| Practice Location | |||||||||
| Address1: | 10451 TWIN RIVERS RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109973557 | ||||||||
| FaxNumber: | 4109641791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2010 | ||||||||
| LastUpdateDate: | 02/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 13023 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 238486 | 01 | JHHC | OTHER | 294213 | 01 | KAISER PERMANENTE | OTHER | 031318100 | 05 | MD | MEDICAID | 100143783 | 01 | APS HEALTHCARE | OTHER | 966369-01 | 01 | MD | CAREFIRST (MD #) | OTHER | T541-0112 | 01 | MD | CAREFIRST | OTHER |