Healthcare Provider Details

I. General information

NPI: 1396075776
Provider Name (Legal Business Name): MARILYN CIMONETTI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9437 PENFIELD RD N
COLUMBIA MD
21045-2260
US

IV. Provider business mailing address

9437 N. PENFIELD RD
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-2224
  • Fax:
Mailing address:
  • Phone: 410-730-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2717
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: