Healthcare Provider Details

I. General information

NPI: 1548319825
Provider Name (Legal Business Name): TINA MARIE ALLEN MSW, LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 GOOSE CREEK WAY
FREDERICK MD
21702-6034
US

IV. Provider business mailing address

2012 GOOSE CREEK WAY
FREDERICK MD
21702-6034
US

V. Phone/Fax

Practice location:
  • Phone: 301-473-2009
  • Fax:
Mailing address:
  • Phone: 202-679-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLC50078369
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006363
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19625
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078369
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC50078369
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: