Provider Demographics
NPI:1346789500
Name:NUSSBAUM, MALGORZATA (MFT, LAC)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MFT, LAC
Other - Prefix:
Other - First Name:MALGORZATA
Other - Middle Name:
Other - Last Name:WURINARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT, LAC
Mailing Address - Street 1:2018 ROCK SPRING RD STE A6
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2631
Mailing Address - Country:US
Mailing Address - Phone:410-838-2493
Mailing Address - Fax:410-838-2597
Practice Address - Street 1:2018 ROCK SPRING RD STE A6
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2631
Practice Address - Country:US
Practice Address - Phone:410-838-2493
Practice Address - Fax:410-838-2597
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000244101YA0400X
CO0001347106H00000X
MDLCM665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty