Healthcare Provider Details

I. General information

NPI: 1295648012
Provider Name (Legal Business Name): DR MARLA VANNUCCI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 DEMOCRACY BLVD
BETHESDA MD
20817-1664
US

IV. Provider business mailing address

5551 HIGH TOR HL
COLUMBIA MD
21045-2465
US

V. Phone/Fax

Practice location:
  • Phone: 773-412-0872
  • Fax:
Mailing address:
  • Phone: 773-412-0872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARLA VANNUCCI
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 773-412-0872