Healthcare Provider Details

I. General information

NPI: 1578238465
Provider Name (Legal Business Name): TAMARA SPENCE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HWY STE 300
WALDORF MD
20601-2817
US

IV. Provider business mailing address

PO BOX 129
HOLLYWOOD MD
20636-0129
US

V. Phone/Fax

Practice location:
  • Phone: 301-373-3065
  • Fax: 240-309-4131
Mailing address:
  • Phone: 301-373-3065
  • Fax: 240-309-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: