Provider Demographics
NPI:1023790417
Name:LANZILOTTA, JENNIFER L (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LANZILOTTA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S FOUNTAIN GREEN RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-4718
Mailing Address - Country:US
Mailing Address - Phone:667-201-8256
Mailing Address - Fax:443-390-1136
Practice Address - Street 1:4211 BLAKELY AVE STE 201
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2458
Practice Address - Country:US
Practice Address - Phone:443-567-7037
Practice Address - Fax:443-390-1136
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30434104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker