1144938333 NPI number — MS. VICTORIA RENEE KELLY ROBLES LMSW

Table of content: MS. VICTORIA RENEE KELLY ROBLES LMSW (NPI 1144938333)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144938333 NPI number — MS. VICTORIA RENEE KELLY ROBLES LMSW

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
KELLY ROBLES

Provider First Name:
VICTORIA

Provider Middle Name:
RENEE

Provider Name Prefix Text:
MS.

Provider Name Suffix Text:

Provider Credential Text:
LMSW

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
KELLY

Provider Other First Name:
VICTORIA

Provider Other Middle Name:
RENEE

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144938333

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
11/07/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8849 THOMAS LEA TER

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
MONTGOMERY VILLAGE

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
20886-4347

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
443-880-0828

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11720 BELTSVILLE DR STE 500-A18

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
BELTSVILLE

Provider Business Practice Location Address State Name:
MD

Provider Business Practice Location Address Postal Code:
20705-3166

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
240-696-9200

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
11/07/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 104100000X , with the licence number: 27386 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .