Healthcare Provider Details

I. General information

NPI: 1164811345
Provider Name (Legal Business Name): JEANNE S CENTOFANTI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 BUCKEYSTOWN PIKE STE 250
FREDERICK MD
21704-8344
US

IV. Provider business mailing address

6196 OXON HILL RD STE 340
OXON HILL MD
20745-3134
US

V. Phone/Fax

Practice location:
  • Phone: 240-384-3442
  • Fax: 720-428-2956
Mailing address:
  • Phone: 410-736-8704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP5908
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: