Healthcare Provider Details

I. General information

NPI: 1710402383
Provider Name (Legal Business Name): ELIZABETH MARY EMEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MARY KUTTLER

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W REDWOOD ST STE 4801
BALTIMORE MD
21201-1708
US

IV. Provider business mailing address

306 W REDWOOD ST STE 4801
BALTIMORE MD
21201-1708
US

V. Phone/Fax

Practice location:
  • Phone: 646-665-1526
  • Fax: 646-878-9691
Mailing address:
  • Phone: 802-578-5794
  • Fax: 646-878-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC5549
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: