Provider Demographics
NPI:1225870363
Name:MARRAZZO, ERIN (MA,LGPC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MARRAZZO
Suffix:
Gender:F
Credentials:MA,LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 INTERTIDAL LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2167
Mailing Address - Country:US
Mailing Address - Phone:814-969-4719
Mailing Address - Fax:
Practice Address - Street 1:900 BESTGATE RD STE 210
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7922
Practice Address - Country:US
Practice Address - Phone:410-267-3706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15730101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty