Provider Demographics
NPI:1003968439
Name:DEJANIKUS, TACIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:TACIE
Middle Name:
Last Name:DEJANIKUS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 BANGOR DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1106
Mailing Address - Country:US
Mailing Address - Phone:301-933-1799
Mailing Address - Fax:
Practice Address - Street 1:1398 LAMBERTON DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3414
Practice Address - Country:US
Practice Address - Phone:301-754-1102
Practice Address - Fax:301-754-1690
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical