Individual
KELLY QUEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1421 CLARKVIEW RD STE 130, BALTIMORE, MD 21209-2184
(844) 854-1116
Mailing address
9096 REXIS AVE, PERRY HALL, MD 21128-9021
(443) 453-2031
(443) 216-7397
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-63087
MD
103K00000X
Behavior Analyst
1471
MD
106S00000X
Behavior Technician
RBT-19-105390
MD
Other
Enumeration date
05/20/2021
Last updated
03/27/2023
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