Healthcare Provider Details

I. General information

NPI: 1225870363
Provider Name (Legal Business Name): ERIN MARRAZZO MA,LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BESTGATE RD STE 210
ANNAPOLIS MD
21401-7922
US

IV. Provider business mailing address

207 INTERTIDAL LN
LAUREL MD
20724-2167
US

V. Phone/Fax

Practice location:
  • Phone: 410-267-3706
  • Fax:
Mailing address:
  • Phone: 814-969-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP15730
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: