Provider Demographics
NPI:1184333031
Name:MCLUNE, TANIQUE SHAUNDECE (BA)
Entity type:Individual
Prefix:
First Name:TANIQUE
Middle Name:SHAUNDECE
Last Name:MCLUNE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9316 19TH AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2314
Mailing Address - Country:US
Mailing Address - Phone:929-395-9459
Mailing Address - Fax:
Practice Address - Street 1:140 BENCHLEY PL APT 15C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3538
Practice Address - Country:US
Practice Address - Phone:929-395-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health