Provider Demographics
NPI:1699355420
Name:AVILES, TAMARA LYNN (LCSW-C, MSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LYNN
Last Name:AVILES
Suffix:
Gender:F
Credentials:LCSW-C, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2614
Mailing Address - Country:US
Mailing Address - Phone:410-952-7881
Mailing Address - Fax:
Practice Address - Street 1:1009 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5055
Practice Address - Country:US
Practice Address - Phone:410-952-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1649894841Other85-0987206