MEDICARE: TRANSFORMING AND RENEWING YOU

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	11339	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407245327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMING AND RENEWING YOU

Provider Business Mailing Address
First Line	:	2517 N CHARLES ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4602
Country	:	US
Telephone Number	:	443-939-5223
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 N CHARLES ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4602
Country	:	US
Telephone Number	:	443-939-5223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATAVIA M LITTLE
Credential	:	LCSW-C
Telephone Number	:	443-939-5223

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “TRANSFORMING AND RENEWING YOU ” Practice Location

Language	Start Address	Practice Location

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