Provider Demographics
NPI:1750750691
Name:TAYLOR- FENTRESS, AURORA (LCSW-C)
Entity type:Individual
Prefix:
First Name:AURORA
Middle Name:
Last Name:TAYLOR- FENTRESS
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 1:8903 BOXFORD CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2416
Mailing Address - Country:US
Mailing Address - Phone:240-460-6479
Mailing Address - Fax:
Practice Address - Street 1:8903 BOXFORD CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2416
Practice Address - Country:US
Practice Address - Phone:240-460-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21162104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker