Provider Demographics
NPI:1992409536
Name:DISEBASTIANO, MARIA NICOLA (CERTIFIED COACH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:NICOLA
Last Name:DISEBASTIANO
Suffix:
Gender:F
Credentials:CERTIFIED COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 GOLDEN ROD CT UNIT C
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1661
Mailing Address - Country:US
Mailing Address - Phone:410-598-4604
Mailing Address - Fax:
Practice Address - Street 1:1401 GOLDEN ROD CT UNIT C
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1661
Practice Address - Country:US
Practice Address - Phone:410-598-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach