MEDICARE: TIANA MARIE HARDAWAY

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	100561	CA

General Provider Information

NPI Number	:	1609652940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANA MARIE HARDAWAY

Provider Business Mailing Address
First Line	:	6119 CHRISTINE LN
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1170
Country	:	US
Telephone Number	:	310-590-5991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1336 16TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1804
Country	:	US
Telephone Number	:	424-440-3965
Fax Number	:

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

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	09/04/2023

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Directions to “ TIANA MARIE HARDAWAY ” Practice Location

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