Provider Demographics
NPI:1376699579
Name:VINCITORE, MARY D (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:VINCITORE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 KINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1922
Mailing Address - Country:US
Mailing Address - Phone:410-615-2387
Mailing Address - Fax:
Practice Address - Street 1:107 E MAPLE RD
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2513
Practice Address - Country:US
Practice Address - Phone:410-615-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD19MVMAOtherCARE FIRST, BCBS
MD53450001OtherGHMSI