MEDICARE: MRS. TINERA JOYCE LOKEMAN LCSW C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	01248	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R4061001	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1902932544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TINERA JOYCE LOKEMAN LCSW C

Provider Business Mailing Address
First Line	:	4211 VERMONT AVENUE
Second Line	:	LUTHERAN CHURCH OF REDEEMER
City	:	BALTIMORE
State	:	MD
Zip	:	21229
Country	:	US
Telephone Number	:	410-644-6780
Fax Number	:	410-644-6781

Provider Business Practice Location Address
First Line	:	4211 VERMONT AVENUE
Second Line	:	LUTHERAN CHURCH OF REDEEMER
City	:	BALTIMORE
State	:	MD
Zip	:	21229
Country	:	US
Telephone Number	:	410-644-6780
Fax Number	:	410-644-6781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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