Healthcare Provider Details

I. General information

NPI: 1942646088
Provider Name (Legal Business Name): STEPHANIE DOLORES TAFT LGSW, CAC-AD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 FALLSWAY
BALTIMORE MD
21202-4800
US

IV. Provider business mailing address

3323 LYNDALE AVE
BALTIMORE MD
21213-1609
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-5533
  • Fax:
Mailing address:
  • Phone: 410-327-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAC1718
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17226
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: