Provider Demographics
NPI:1689971681
Name:JUPITER, TOMEAKA SCHWAN (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TOMEAKA
Middle Name:SCHWAN
Last Name:JUPITER
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 1:909 MINGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2823 CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1619
Practice Address - Country:US
Practice Address - Phone:410-828-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical