Provider Demographics
NPI:1033509021
Name:PETRUCCI, LOREDANA (PHD)
Entity type:Individual
Prefix:
First Name:LOREDANA
Middle Name:
Last Name:PETRUCCI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LOREDANNA
Other - Middle Name:
Other - Last Name:MCCARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:9649 BELAIR RD STE 104
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1117
Mailing Address - Country:US
Mailing Address - Phone:410-529-1309
Mailing Address - Fax:410-529-1005
Practice Address - Street 1:9649 BELAIR RD STE 104
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1117
Practice Address - Country:US
Practice Address - Phone:410-529-1309
Practice Address - Fax:410-529-1005
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05616103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist