Healthcare Provider Details

I. General information

NPI: 1619546108
Provider Name (Legal Business Name): TAYLOR LUALLEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7658 BELAIR RD
NOTTINGHAM MD
21236-4020
US

IV. Provider business mailing address

909 RAMBLE RUN ROAD
MIDDLE RIVER MD
21220
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 443-801-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number27351
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: