Healthcare Provider Details

I. General information

NPI: 1295349256
Provider Name (Legal Business Name): MAURA TUNNEY, LCSW-C, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2020
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 FREDERICK RD
CATONSVILLE MD
21228-5055
US

IV. Provider business mailing address

1009 FREDERICK RD
CATONSVILLE MD
21228-5055
US

V. Phone/Fax

Practice location:
  • Phone: 667-444-2334
  • Fax:
Mailing address:
  • Phone: 667-444-2334
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAURA TUNNEY
Title or Position: OWNER/THERAPIST
Credential: LCSW-C
Phone: 667-444-2334