Provider Demographics
NPI:1982676953
Name:CATUCCI, TERESA L (MSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:CATUCCI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:CATUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2110 PRIEST BRIDGE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2472
Mailing Address - Country:US
Mailing Address - Phone:240-460-2796
Mailing Address - Fax:
Practice Address - Street 1:2110 PRIEST BRIDGE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2472
Practice Address - Country:US
Practice Address - Phone:240-460-2796
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119 SMedicare ID - Type UnspecifiedPROVIDER NUMBER