Healthcare Provider Details

I. General information

NPI: 1619372976
Provider Name (Legal Business Name): LAUREN ZOLLUCCIO LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E PADONIA RD STE 202
LUTHERVILLE TIMONIUM MD
21093-2308
US

IV. Provider business mailing address

204 SAINT CHARLES WAY UNIT E, BOX 372
YORK PA
17402-4646
US

V. Phone/Fax

Practice location:
  • Phone: 443-367-1333
  • Fax:
Mailing address:
  • Phone: 443-367-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26285
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26285
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: