Provider Demographics
NPI:1184497323
Name:KUTNER, CASEY GIOVANAZZI (LCPC)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:GIOVANAZZI
Last Name:KUTNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MISS
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:GIOVANAZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGPC
Mailing Address - Street 1:3 N LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-1246
Mailing Address - Country:US
Mailing Address - Phone:443-745-7503
Mailing Address - Fax:
Practice Address - Street 1:2021A EMMORTON RD STE 210
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8965
Practice Address - Country:US
Practice Address - Phone:443-745-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14456101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor