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General NPI Number Information
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NPI Number | 1356159412
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Entity Type | Individual
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Provider Name | TANASIA HAZELTON LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 5820 YORK RD STE 201
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City | BALTIMORE
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State | MD
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Zip | 21212-3620
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Country | US
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Telephone | 202-743-6208
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 CROFTON RD
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City | BALTIMORE
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State | MD
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Zip | 21239-3934
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Country | US
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Telephone | 202-743-6208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 29754
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License Number State | MD
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