Healthcare Provider Details

I. General information

NPI: 1689198558
Provider Name (Legal Business Name): MARION ELIZABETH TOSCANO LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 SOUTH JEFFERSON STREET
FREDERICK MD
31701
US

IV. Provider business mailing address

226 SOUTH JEFFERSON STREET
FREDERICK MD
21701
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-6135
  • Fax:
Mailing address:
  • Phone: 301-663-6135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP6081
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLGP6081
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP6081
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: