Provider Demographics
NPI:1891207163
Name:TROVATO, JESSE (LGPC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:TROVATO
Suffix:
Gender:
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 WOODRIDGE MANOR RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2656
Mailing Address - Country:US
Mailing Address - Phone:410-625-1600
Mailing Address - Fax:
Practice Address - Street 1:1407 WOODRIDGE MANOR RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2656
Practice Address - Country:US
Practice Address - Phone:410-625-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9856101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional