Healthcare Provider Details

I. General information

NPI: 1184674343
Provider Name (Legal Business Name): CARLOMAGNO C PANLILIO LCMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 GEORGIA AVE SUITE # 203
SILVER SPRING MD
20910-1439
US

IV. Provider business mailing address

9525 GEORGIA AVE SUITE # 203
SILVER SPRING MD
20910-1439
US

V. Phone/Fax

Practice location:
  • Phone: 702-588-4048
  • Fax:
Mailing address:
  • Phone: 702-588-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF01108
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM365
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: