Provider Demographics
NPI:1255901955
Name:MARTIN, TARAH LEA (LCSW-C)
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:LEA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEST RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2370
Mailing Address - Country:US
Mailing Address - Phone:717-851-8771
Mailing Address - Fax:
Practice Address - Street 1:100 WEST RD STE 300
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2370
Practice Address - Country:US
Practice Address - Phone:717-851-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD257331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty