MEDICARE: ANTHONY DER 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	101YM0800X	Mental Health Counselor	LC8466	MD

General Provider Information

NPI Number	:	1275025512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY DER LCPC

Provider Business Mailing Address
First Line	:	6611 CAMBRIA TER
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-5952
Country	:	US
Telephone Number	:	443-718-0385
Fax Number	:

Provider Business Practice Location Address
First Line	:	10705 CHARTER DR STE 410
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2800
Country	:	US
Telephone Number	:	443-718-0385
Fax Number	:

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

Provider Enumeration Date	:	06/02/2018
Last Update Date	:	06/02/2018

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Directions to “ ANTHONY DER LCPC” Practice Location

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