1962680645 NPI number — MRS. KATHERINE ANN BONINCONTRI LCPC

Table of content: MRS. KATHERINE ANN BONINCONTRI LCPC (NPI 1962680645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962680645 NPI number — MRS. KATHERINE ANN BONINCONTRI LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONINCONTRI
Provider First Name:
KATHERINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROVENDRO
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962680645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 180
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODENTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21113-0180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-975-0067
Provider Business Mailing Address Fax Number:
410-975-0204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
741 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAMBRILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21054-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-975-0067
Provider Business Practice Location Address Fax Number:
410-975-0204
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LC2400 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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