Provider Demographics
NPI:1720150741
Name:PATENTE, MARIANNA JEANNE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARIANNA
Middle Name:JEANNE
Last Name:PATENTE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 CRAIN HIGHWAY
Mailing Address - Street 2:SUITE #401
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601
Mailing Address - Country:US
Mailing Address - Phone:301-704-5611
Mailing Address - Fax:
Practice Address - Street 1:2670 CRAIN HIGHWAY
Practice Address - Street 2:SUITE #401
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601
Practice Address - Country:US
Practice Address - Phone:301-704-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1126101Y00000X
VA0701003222101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0070001OtherBCBS CARE FIRST
177237OtherANTHEM