Healthcare Provider Details

I. General information

NPI: 1750708160
Provider Name (Legal Business Name): EVE MAITLAND TAGLANG LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W MAIN ST A
NEW MARKET MD
21774-6279
US

IV. Provider business mailing address

164 WEST MAIN STREET A
NEW MARKET MD
21774
US

V. Phone/Fax

Practice location:
  • Phone: 301-865-2226
  • Fax:
Mailing address:
  • Phone: 301-865-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15462
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: