Healthcare Provider Details

I. General information

NPI: 1336340546
Provider Name (Legal Business Name): PERRYN GUTKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 ANNAPOLIS RD SUITE F
ODENTON MD
21113-1387
US

IV. Provider business mailing address

1762 SEA PINE CIR
SEVERN MD
21144-1815
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-2862
  • Fax: 410-672-2869
Mailing address:
  • Phone: 410-551-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number72072530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: