Healthcare Provider Details

I. General information

NPI: 1245745108
Provider Name (Legal Business Name): SUSAN LLUFRIO C.S.C-A.D, A.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W COURTLAND ST
BEL AIR MD
21014-3701
US

IV. Provider business mailing address

21 W COURTLAND ST
BEL AIR MD
21014-3701
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-3442
  • Fax: 410-838-3341
Mailing address:
  • Phone: 410-838-3442
  • Fax: 410-838-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSC0973
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: