Provider Demographics
NPI:1194964494
Name:PORRETTI, ANNE MARIE (LCPC)
Entity type:Individual
Prefix:MS
First Name:ANNE MARIE
Middle Name:
Last Name:PORRETTI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 GOLDEN RING ROAD
Mailing Address - Street 2:UNIT 9564
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:410-497-5173
Mailing Address - Fax:
Practice Address - Street 1:2303 BELAIR ROAD
Practice Address - Street 2:STE B
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2104
Practice Address - Country:US
Practice Address - Phone:410-497-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD311823751OtherTAX ID
MD1003848490OtherNPI
MD1013196120OtherGROUP NTI
MD201965602OtherTAX ID