Healthcare Provider Details

I. General information

NPI: 1336034073
Provider Name (Legal Business Name): TAMMY BRADSHAW-MAYO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY BRADSHAW N/A

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N HOWARD ST
BALTIMORE MD
21218-5909
US

IV. Provider business mailing address

3220 BERKSHIRE RD
BALTIMORE MD
21214-3406
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-6742
  • Fax:
Mailing address:
  • Phone: 410-670-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32964
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: