Healthcare Provider Details

I. General information

NPI: 1598596660
Provider Name (Legal Business Name): CHRISTINE ZILUCA LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 ILCHESTER WOODS WAY
ELLICOTT CITY MD
21043-6306
US

IV. Provider business mailing address

5104 ILCHESTER WOODS WAY
ELLICOTT CITY MD
21043-6306
US

V. Phone/Fax

Practice location:
  • Phone: 410-258-3449
  • Fax:
Mailing address:
  • Phone: 410-258-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08668
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: