Provider Demographics
NPI:1013786896
Name:ISOM, TUESDAY R (LMSW)
Entity Type:Individual
Prefix:
First Name:TUESDAY
Middle Name:R
Last Name:ISOM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 OLD COURT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3906
Mailing Address - Country:US
Mailing Address - Phone:404-433-2153
Mailing Address - Fax:
Practice Address - Street 1:3635 OLD COURT RD STE 201
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3906
Practice Address - Country:US
Practice Address - Phone:404-433-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21392104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker