Provider Demographics
NPI:1306483532
Name:BROKEN OPEN COUNSELING LLC
Entity type:Organization
Organization Name:BROKEN OPEN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:GIOIOSO
Authorized Official - Last Name:KERYAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-598-8871
Mailing Address - Street 1:102 W PENNSYLVANIA AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4526
Mailing Address - Country:US
Mailing Address - Phone:410-598-8871
Mailing Address - Fax:
Practice Address - Street 1:102 W PENNSYLVANIA AVE STE 400
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4526
Practice Address - Country:US
Practice Address - Phone:410-598-8871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty