Provider Demographics
NPI:1730399015
Name:WHORTON, KELLY JOY (LCSW-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JOY
Last Name:WHORTON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1905
Mailing Address - Country:US
Mailing Address - Phone:410-744-6148
Mailing Address - Fax:410-252-1268
Practice Address - Street 1:3677 PARK AVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4511
Practice Address - Country:US
Practice Address - Phone:443-286-0735
Practice Address - Fax:410-252-1268
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical