Provider Demographics
NPI:1215571955
Name:CASON, TYMEL OCTAVIA (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:TYMEL
Middle Name:OCTAVIA
Last Name:CASON
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:MS
Other - First Name:TYMEL
Other - Middle Name:OCTAVIA
Other - Last Name:CASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWC
Mailing Address - Street 1:12073 TECH RD STE B
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7874
Mailing Address - Country:US
Mailing Address - Phone:301-747-4364
Mailing Address - Fax:301-747-4569
Practice Address - Street 1:12073 TECH RD STE B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7874
Practice Address - Country:US
Practice Address - Phone:301-747-4364
Practice Address - Fax:301-747-4569
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD250809651106OtherDL
MDC-250-809-651-106Other19442