Healthcare Provider Details

I. General information

NPI: 1740811587
Provider Name (Legal Business Name): LUCIANA LAVORATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 FREDERICK AVE
BALTIMORE MD
21229-3618
US

IV. Provider business mailing address

PO BOX 136, 9701 KEYSVILLE ROAD
EMMITSBURG MD
21727
US

V. Phone/Fax

Practice location:
  • Phone: 410-233-1400
  • Fax:
Mailing address:
  • Phone: 301-447-2361
  • Fax: 301-447-3673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP7964
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: