Provider Demographics
NPI:1811712029
Name:PANETTA, LAURIE LEE (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:LEE
Last Name:PANETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3332
Mailing Address - Country:US
Mailing Address - Phone:301-268-4088
Mailing Address - Fax:
Practice Address - Street 1:425 PACA ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2818
Practice Address - Country:US
Practice Address - Phone:301-724-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool