Provider Demographics
NPI:1336579762
Name:TALIAFERRO, FLOYD E IV (LGSW)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:E
Last Name:TALIAFERRO
Suffix:IV
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 MARLORA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1929
Mailing Address - Country:US
Mailing Address - Phone:410-262-7104
Mailing Address - Fax:
Practice Address - Street 1:2510 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4760
Practice Address - Country:US
Practice Address - Phone:410-558-0032
Practice Address - Fax:410-366-2108
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18615104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker