MEDICARE: KALELEI H TAWATA LCSW-C

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	1041C0700X	Clinical Social Worker	14772	MD

General Provider Information

NPI Number	:	1093156259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALELEI H TAWATA LCSW-C

Provider Business Mailing Address
First Line	:	629 MARPETE DR
Second Line	:
City	:	HAMPSTEAD
State	:	MD
Zip	:	21074-1740
Country	:	US
Telephone Number	:	410-294-9612
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 ENGLAR RD STE 10
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-2927
Country	:	US
Telephone Number	:	410-294-9612
Fax Number	:

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

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	09/03/2025

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