Healthcare Provider Details

I. General information

NPI: 1336979368
Provider Name (Legal Business Name): TAYRA LUDITH GARCIA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 HARBOR RD UNIT 103
CHESAPEAKE BEACH MD
20732-3110
US

IV. Provider business mailing address

7473 CAVALCADE DR
CHESAPEAKE BEACH MD
20732-4102
US

V. Phone/Fax

Practice location:
  • Phone: 410-286-0547
  • Fax:
Mailing address:
  • Phone: 410-610-2987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number31942
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: