Healthcare Provider Details

I. General information

NPI: 1306186820
Provider Name (Legal Business Name): TAMARA LYNN KOEPP LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N JEFFERSON ST
FREDERICK MD
21701-3500
US

IV. Provider business mailing address

10 N JEFFERSON ST STE 403
FREDERICK MD
21701-4823
US

V. Phone/Fax

Practice location:
  • Phone: 301-514-4745
  • Fax: 301-668-1854
Mailing address:
  • Phone: 301-514-4745
  • Fax: 301-668-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17036
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: