Provider Demographics
NPI:1104181205
Name:CHIRAYATH, ANIL L (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ANIL
Middle Name:L
Last Name:CHIRAYATH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 PARK AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5633
Mailing Address - Country:US
Mailing Address - Phone:410-837-3977
Mailing Address - Fax:410-752-4218
Practice Address - Street 1:621 STEMMERS RUN RD STE E
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3386
Practice Address - Country:US
Practice Address - Phone:410-574-2500
Practice Address - Fax:410-574-4478
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4398101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor