MEDICARE: MRS. MARY JOANNA PUGLISI LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC6799	MD

General Provider Information

NPI Number	:	1063059392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY JOANNA PUGLISI LCPC

Provider Business Mailing Address
First Line	:	6310 STEVENS FOREST RD
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-1036
Country	:	US
Telephone Number	:	410-740-3240
Fax Number	:

Provider Business Practice Location Address
First Line	:	6310 STEVENS FOREST RD
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-1036
Country	:	US
Telephone Number	:	410-740-3240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	12/05/2019

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