Healthcare Provider Details

I. General information

NPI: 1669785622
Provider Name (Legal Business Name): TANESHA ROCHELLE MAYO LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 ELTON RD SUITE 204
SILVER SPRING MD
20903-1740
US

IV. Provider business mailing address

5455 COLUMBIA RD APT. 224
COLUMBIA MD
21044-5572
US

V. Phone/Fax

Practice location:
  • Phone: 301-439-7191
  • Fax:
Mailing address:
  • Phone: 443-319-5149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15284
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: