Provider Demographics
NPI:1831103431
Name:TABB, STUART
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:TABB
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 1:339 STONECASTLE AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3522
Mailing Address - Country:US
Mailing Address - Phone:443-769-2865
Mailing Address - Fax:443-769-2865
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE 407
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:443-279-2000
Practice Address - Fax:443-279-2004
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD026561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical