Provider Demographics
NPI:1215159512
Name:NAZZARO, MARIE S (LCPC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:S
Last Name:NAZZARO
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 1:21770 FDR BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-1558
Mailing Address - Country:US
Mailing Address - Phone:301-997-1300
Mailing Address - Fax:301-866-9189
Practice Address - Street 1:21770 FDR BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1558
Practice Address - Country:US
Practice Address - Phone:301-997-1300
Practice Address - Fax:301-866-9189
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCPC2711101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD58956180Medicaid
MD58956180Medicaid