Healthcare Provider Details

I. General information

NPI: 1184962912
Provider Name (Legal Business Name): TIFFANY RENE ADAMS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E LOMBARD ST
BALTIMORE MD
21224-1731
US

IV. Provider business mailing address

5500 E LOMBARD ST
BALTIMORE MD
21224-1731
US

V. Phone/Fax

Practice location:
  • Phone: 104-550-0019
  • Fax: 410-550-1748
Mailing address:
  • Phone: 104-550-0019
  • Fax: 410-550-1748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17596
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: