Provider Demographics
NPI:1659472090
Name:LABAN, MARQUERITE PETRANELLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARQUERITE
Middle Name:PETRANELLA
Last Name:LABAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 DEERECO RD STE 410
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2124
Mailing Address - Country:US
Mailing Address - Phone:410-560-6135
Mailing Address - Fax:410-560-6136
Practice Address - Street 1:9475 DEERECO RD STE 410
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2124
Practice Address - Country:US
Practice Address - Phone:410-560-6135
Practice Address - Fax:410-560-6136
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05420103TC0700X, 103TC0700X
PAPC005478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional