Provider Demographics
NPI:1063146934
Name:PADELETTI, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:PADELETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 FAIRBANKS DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1623
Mailing Address - Country:US
Mailing Address - Phone:443-805-1782
Mailing Address - Fax:
Practice Address - Street 1:1997 ANNAPOLIS EXCHANGE PKWY STE 180
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3272
Practice Address - Country:US
Practice Address - Phone:443-924-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional