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1033171061

NPI Code Detail

MEDICARE: MS. SUSAN ANN TANGIRES LCPC LCADC

MEDICARE: MS. SUSAN ANN TANGIRES LCPC LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCA343	MD
2	101YP2500X	Professional Counselor	LC1260	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0089	OTHER		BS FEDERAL GROUP S003
2	328196	OTHER		MHN AND TRICARE
3	487506	OTHER		VALUE OPTIONS GREAT WEST
4	11554503	OTHER		CAQH
5	721298000	OTHER		MAGELLAN BEHAVIORAL HEALT
6	522229157	OTHER		PHCS
7	2124028	OTHER		MAMSI UNITED HEALTH CARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7284589	OTHER		AETNA BEHAVIORAL HEALTH
10	100072697	OTHER		APS
11	63662901	OTHER	MD	BLUE SHIELD

General Provider Information

NPI Number	:	1033171061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN ANN TANGIRES LCPC LCADC

Provider Business Mailing Address
First Line	:	3134 CHATHAM CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2410
Country	:	US
Telephone Number	:	410-465-8448
Fax Number	:	410-744-9423

Provider Business Practice Location Address
First Line	:	800 INGLESIDE AVE
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-1722
Country	:	US
Telephone Number	:	410-744-5937
Fax Number	:	410-744-9423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	11/14/2016

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Directions to “ MS. SUSAN ANN TANGIRES LCPC LCADC” Practice Location

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