Provider Demographics
NPI:1407318512
Name:LUSTIG MARUDAS, GRACE (LCPC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LUSTIG MARUDAS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:MARUDAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1724 EUTAW PL APT 1B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 E JOPPA RD STE 106
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3203
Practice Address - Country:US
Practice Address - Phone:410-337-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional