Healthcare Provider Details

I. General information

NPI: 1285152405
Provider Name (Legal Business Name): MICHAEL ROCCO BOINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST RD STE 300
TOWSON MD
21204-2370
US

IV. Provider business mailing address

100 WEST RD STE 300
TOWSON MD
21204-2370
US

V. Phone/Fax

Practice location:
  • Phone: 410-417-8197
  • Fax:
Mailing address:
  • Phone: 410-417-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26277
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: