Provider Demographics
NPI:1306206412
Name:DUBEAU, TANIA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:DUBEAU
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 UNIVERSITY BLVD W
Mailing Address - Street 2:THE PATHWAYS SCHOOLS
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1106 UNIVERSITY BLVD W
Practice Address - Street 2:THE PATHWAYS SCHOOLS
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3302
Practice Address - Country:US
Practice Address - Phone:301-649-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD067491041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool