Provider Demographics
NPI:1770622367
Name:HAWN, TAVI (LCSW-C)
Entity type:Individual
Prefix:
First Name:TAVI
Middle Name:
Last Name:HAWN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:TAVI
Other - Middle Name:
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MSW
Mailing Address - Street 1:411 E LAKE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2548
Mailing Address - Country:US
Mailing Address - Phone:443-415-2593
Mailing Address - Fax:
Practice Address - Street 1:5717 FALLS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3707
Practice Address - Country:US
Practice Address - Phone:443-415-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NCC006592104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770622367OtherNPI