Healthcare Provider Details

I. General information

NPI: 1063175800
Provider Name (Legal Business Name): TACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 RED CEDAR PL
BALTIMORE MD
21209-3830
US

IV. Provider business mailing address

6355 RED CEDAR PL
BALTIMORE MD
21209-3830
US

V. Phone/Fax

Practice location:
  • Phone: 917-968-6641
  • Fax:
Mailing address:
  • Phone: 917-968-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CONNIE MEYEROWITZ
Title or Position: OWNER/MANAGER
Credential: LCSW-C
Phone: 917-968-6641