Provider Demographics
NPI:1235481953
Name:JEFFREY, TASHA MARIE (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:MARIE
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 HARFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4100
Mailing Address - Country:US
Mailing Address - Phone:443-377-1731
Mailing Address - Fax:443-773-0843
Practice Address - Street 1:8901 HARFORD RD STE B
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234
Practice Address - Country:US
Practice Address - Phone:443-377-1731
Practice Address - Fax:443-773-0843
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17493104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD112383100Medicaid