Healthcare Provider Details

I. General information

NPI: 1134736812
Provider Name (Legal Business Name): GABRIELLA NORA FIMIANI LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 EASTERN AVE
BALTIMORE MD
21224-4010
US

IV. Provider business mailing address

2512 CHESTNUT WOODS CT
REISTERSTOWN MD
21136-5523
US

V. Phone/Fax

Practice location:
  • Phone: 410-522-1181
  • Fax:
Mailing address:
  • Phone: 410-591-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08263
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: