Provider Demographics
NPI:1033171061
Name:TANGIRES, SUSAN ANN (LCPC LCADC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANN
Last Name:TANGIRES
Suffix:
Gender:F
Credentials:LCPC LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 CHATHAM CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2410
Mailing Address - Country:US
Mailing Address - Phone:410-465-8448
Mailing Address - Fax:410-744-9423
Practice Address - Street 1:800 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1722
Practice Address - Country:US
Practice Address - Phone:410-744-5937
Practice Address - Fax:410-744-9423
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA343101YA0400X
MDLC1260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0089OtherBS FEDERAL GROUP S003
328196OtherMHN AND TRICARE
487506OtherVALUE OPTIONS GREAT WEST
11554503OtherCAQH
721298000OtherMAGELLAN BEHAVIORAL HEALT
522229157OtherPHCS
2124028OtherMAMSI UNITED HEALTH CARE
MD333404000Medicaid
7284589OtherAETNA BEHAVIORAL HEALTH
100072697OtherAPS
MD63662901OtherBLUE SHIELD