Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 25379 | MD |
NPI | 1003465196 |
---|---|
Provider Name | Elizabeth L Tiedemann |
First Address | Reisterstown, MD 21136-1236 |
Second Address | Westminster, MD 21157-7200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2019 |
Last Update Date | 10/09/2019 |