Provider Demographics
NPI:1437585569
Name:MANYWEATHERS, TANYA RENEE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:RENEE
Last Name:MANYWEATHERS
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 1:3133 RIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2870
Mailing Address - Country:US
Mailing Address - Phone:410-302-8857
Mailing Address - Fax:410-205-2464
Practice Address - Street 1:17 WARREN RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5334
Practice Address - Country:US
Practice Address - Phone:410-205-2464
Practice Address - Fax:410-205-2464
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD188361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical