Provider Demographics
NPI:1659864973
Name:WASHINGTON, TAWANA L
Entity Type:Individual
Prefix:MRS
First Name:TAWANA
Middle Name:L
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 FARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2832
Mailing Address - Country:US
Mailing Address - Phone:267-250-4811
Mailing Address - Fax:
Practice Address - Street 1:1377 FARRINGTON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2832
Practice Address - Country:US
Practice Address - Phone:267-250-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker