Healthcare Provider Details

I. General information

NPI: 1023575354
Provider Name (Legal Business Name): TANYA MCFADDEN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3756 ASHLEY WAY
OWINGS MILLS MD
21117-1400
US

IV. Provider business mailing address

3756 ASHLEY WAY
OWINGS MILLS MD
21117-1400
US

V. Phone/Fax

Practice location:
  • Phone: 410-733-9350
  • Fax:
Mailing address:
  • Phone: 410-733-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11632
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number11632
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: