Healthcare Provider Details

I. General information

NPI: 1851943179
Provider Name (Legal Business Name): AMY E TISSIERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR STE G020
COLUMBIA MD
21044-3257
US

IV. Provider business mailing address

11720 BELTSVILLE DR STE 300
BELTSVILLE MD
20705-3119
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-2212
  • Fax:
Mailing address:
  • Phone: 240-223-1799
  • Fax: 832-348-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: