MEDICARE: DR. OZIETTA DARTANIEL TAYLOR LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC1045	MD

General Provider Information

NPI Number	:	1275714230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OZIETTA DARTANIEL TAYLOR LCPC

Provider Business Mailing Address
First Line	:	5417 DAYWALT AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-4436
Country	:	US
Telephone Number	:	410-585-8780
Fax Number	:

Provider Business Practice Location Address
First Line	:	5417 DAYWALT AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-4436
Country	:	US
Telephone Number	:	410-585-8780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	11/19/2007

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