Provider Demographics
NPI:1437376472
Name:LIBONATI, CAROL ANN (APRN)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:LIBONATI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1828
Mailing Address - Country:US
Mailing Address - Phone:410-243-8306
Mailing Address - Fax:410-243-2507
Practice Address - Street 1:810 LIGHT ST.
Practice Address - Street 2:SUITE 103
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230
Practice Address - Country:US
Practice Address - Phone:410-908-2099
Practice Address - Fax:410-243-2507
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR039456163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002505OtherVALUE OPTIONS
MD9079442OtherMULTIPLAN
MDPQ02CAOtherCAREFIRST BLUE CROSS BLUE
MDIP 276313OtherMAGELLAN
MD167836OtherCOMPSYCH
MD364943OtherMAMSI
MHPVPB101825OtherAMERICAN PSYCH SYSTEMS
MD1049727OtherCIGNA
MDG4640001OtherCAREFIRST FEDERAL EMPLOYE
MD23382OtherEMPLOYEE HEALTH PLAN