=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295648012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR MARLA VANNUCCI LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2026
-----------------------------------------------------
Last Update Date | 09/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6312 DEMOCRACY BLVD
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-1664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-412-0872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5551 HIGH TOR HL
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-412-0872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MARLA VANNUCCI
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 773-412-0872
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------