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MARYANN ETUKUDO
NPI 1073115358
Counselor - Mental Health in Laurel, MD

Active since November 12, 2020PECOS Enrolled
14625 BALTIMORE AVE # 817, LAUREL, MD 20707(240) 806-8401 Get Directions Write a Review

NPPES record last updated: November 12, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Maryann Etukudo NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARYANN ETUKUDO (NPI 1073115358) is an individual mental health provider in Laurel, Maryland and active in the NPI registry since November 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1073115358
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameMARYANN ETUKUDO
Location Address14625 BALTIMORE AVE # 817Laurel, MD 20707-4902
Mailing Address14625 Baltimore Ave # 817Laurel, MD 20707-4902 · (240) 806-8401
Phone(240) 806-8401
Sole ProprietorYes
Medical School CMSOtherGraduated 2018
Enumeration DateNovember 12, 2020
NPPES CertifiedOctober 18, 2020
✔ NPI 1073115358 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
14625 BALTIMORE AVE # 817, Laurel, MD 20707
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Maryann Etukudo is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5991280463
PECOS Enrollment IDI20260402000079
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maryann Etukudo's NPI number?

The NPI number for Maryann Etukudo is 1073115358. It was assigned to this individual provider in the NPPES registry on November 12, 2020.

Where is Maryann Etukudo located?

Maryann Etukudo practices at 14625 Baltimore Ave # 817, Laurel, MD 20707. The listed phone number is (240) 806-8401.

What is Maryann Etukudo's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Maryann Etukudo enrolled in Medicare?

Yes. Maryann Etukudo is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Maryann Etukudo was last updated on November 12, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.