Healthcare Provider Details

I. General information

NPI: 1336579762
Provider Name (Legal Business Name): FLOYD E TALIAFERRO IV LICSW, LCSWC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 25TH ST
BALTIMORE MD
21218-5213
US

IV. Provider business mailing address

6133 MARLORA RD
BALTIMORE MD
21239-1929
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-0032
  • Fax: 410-366-2108
Mailing address:
  • Phone: 410-262-7104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18615
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18615
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50082004
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: