Provider Demographics
NPI:1609331602
Name:BUISE, TUNISIA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TUNISIA
Middle Name:
Last Name:BUISE
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 1:4132 E. JOPPA ROAD STE. 110-#1248
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:443-384-7927
Mailing Address - Fax:410-256-7080
Practice Address - Street 1:4132 E. JOPPA ROAD STE. 110-#1248
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:443-384-7927
Practice Address - Fax:410-256-7080
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD210911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical