MEDICARE: TAWANA MICHELLE LEE MSW, LICSW, LMSW

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	LG50081789	DC
2	1041C0700X	Clinical Social Worker	LC200003333	DC
3	1041C0700X	Clinical Social Worker	30727	MD

General Provider Information

NPI Number	:	1396405072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWANA MICHELLE LEE MSW, LICSW, LMSW

Provider Business Mailing Address
First Line	:	4518 BEECH RD STE 230
Second Line	:
City	:	MARLOW HEIGHTS
State	:	MD
Zip	:	20748-6735
Country	:	US
Telephone Number	:	240-814-8519
Fax Number	:

Provider Business Practice Location Address
First Line	:	4518 BEECH RD STE 230
Second Line	:
City	:	MARLOW HEIGHTS
State	:	MD
Zip	:	20748-6735
Country	:	US
Telephone Number	:	240-814-8519
Fax Number	:

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

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	08/17/2025

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