Provider Demographics
NPI:1124707310
Name:MARZULLO, GRAZIELLA
Entity type:Individual
Prefix:
First Name:GRAZIELLA
Middle Name:
Last Name:MARZULLO
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 1:960 SOUTHERLY RD # J-201
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2622
Mailing Address - Country:US
Mailing Address - Phone:443-289-1529
Mailing Address - Fax:
Practice Address - Street 1:11350 MCCORMICK RD
Practice Address - Street 2:SUITE 800
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:20130
Practice Address - Country:US
Practice Address - Phone:410-800-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30219101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool