Provider Demographics
NPI:1952586810
Name:ALTVATER, VERONICA (LCPC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:ALTVATER
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 1:1205 YORK ROAD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-298-8223
Mailing Address - Fax:410-298-8225
Practice Address - Street 1:1205 YORK RD
Practice Address - Street 2:SUITE 21
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6210
Practice Address - Country:US
Practice Address - Phone:410-298-8223
Practice Address - Fax:410-298-8225
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional