Healthcare Provider Details

I. General information

NPI: 1902489925
Provider Name (Legal Business Name): TYTIANNA DOW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 GATEWAY DR STE 9B
BEL AIR MD
21014-4128
US

IV. Provider business mailing address

260 GATEWAY DR STE 9B
BEL AIR MD
21014-4128
US

V. Phone/Fax

Practice location:
  • Phone: 410-403-3299
  • Fax:
Mailing address:
  • Phone: 410-403-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34554
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: