Healthcare Provider Details

I. General information

NPI: 1184497323
Provider Name (Legal Business Name): CASEY GIOVANAZZI KUTNER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASEY GIOVANAZZI LGPC

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021A EMMORTON RD STE 210
BEL AIR MD
21015-8965
US

IV. Provider business mailing address

3 N LINWOOD AVE
BALTIMORE MD
21224-1246
US

V. Phone/Fax

Practice location:
  • Phone: 443-745-7503
  • Fax:
Mailing address:
  • Phone: 443-745-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC14456
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: