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NPI Code Detail

MEDICARE: MS. TIFFANY FAITH PARKS MSW

MEDICARE: MS. TIFFANY FAITH PARKS MSW
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
1104100000XSocial Worker
21041C0700XClinical Social Worker19332MD

General Provider Information

NPI Number : 1093087496
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TIFFANY FAITH PARKS MSW
Provider Business Mailing Address
First Line : 9627 PHILADELPHIA RD STE 160
Second Line :
City : ROSEDALE
State : MD
Zip : 21237-4157
Country : US
Telephone Number : 410-780-0594
Fax Number :
Provider Business Practice Location Address
First Line : 9627 PHILADELPHIA RD STE 160
Second Line :
City : ROSEDALE
State : MD
Zip : 21237-4157
Country : US
Telephone Number : 410-780-0594
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2012
Last Update Date : 04/18/2022

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