Provider Demographics
NPI:1952854929
Name:TATUM, ROSE (LGSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:TATUM
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 PHILADELPHIA CT STE R
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4435
Mailing Address - Country:US
Mailing Address - Phone:301-477-3339
Mailing Address - Fax:443-773-5624
Practice Address - Street 1:3625 ROCKDALE TER
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-3731
Practice Address - Country:US
Practice Address - Phone:443-717-0836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG10908104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker