Healthcare Provider Details

I. General information

NPI: 1598463556
Provider Name (Legal Business Name): MEAGHAN TINE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF MARYLAND MEDICAL CENTER 22 S. GREENE STREET
BALTIMORE MD
21201
US

IV. Provider business mailing address

351 W CAMDEN ST UNIT 501
BALTIMORE MD
21201-7912
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-2661
  • Fax:
Mailing address:
  • Phone: 410-448-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20253
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: