Provider Demographics
NPI:1487413894
Name:FOGLER, VANESSA MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:MARIE
Last Name:FOGLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28486 PINEHURST CIR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8332
Mailing Address - Country:US
Mailing Address - Phone:443-900-4321
Mailing Address - Fax:
Practice Address - Street 1:3 N HARRISON ST STE 200
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3188
Practice Address - Country:US
Practice Address - Phone:443-937-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional