Provider Demographics
NPI:1003601436
Name:LAFALAISE, TANYA (CPRP)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:LAFALAISE
Suffix:
Gender:
Credentials:CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MARINERS WAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3059
Mailing Address - Country:US
Mailing Address - Phone:443-787-8189
Mailing Address - Fax:
Practice Address - Street 1:22 W PENNSYLVANIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5017
Practice Address - Country:US
Practice Address - Phone:410-330-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD75562276171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator