Provider Demographics
NPI:1003031832
Name:VIGGIANI, MARY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:VIGGIANI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CEDARMERE RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2405
Mailing Address - Country:US
Mailing Address - Phone:410-356-4069
Mailing Address - Fax:
Practice Address - Street 1:10151 YORK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3314
Practice Address - Country:US
Practice Address - Phone:410-887-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA301101YA0400X
MD097761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical