Provider Demographics
NPI:1346421724
Name:NELSON, TAMMY DENISE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:DENISE
Last Name:NELSON
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 1:1777 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1306
Mailing Address - Country:US
Mailing Address - Phone:410-480-2055
Mailing Address - Fax:410-580-2058
Practice Address - Street 1:1777 REISTERSTOWN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1306
Practice Address - Country:US
Practice Address - Phone:410-480-2055
Practice Address - Fax:410-580-2058
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD099971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0010001OtherCAREFIRST
MD2151426OtherCIGNA