Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 18454 | MD |
NPI | 1003240987 |
---|---|
Provider Name | Tara Rice |
First Address | Baltimore, MD 21215-0042 |
Second Address | Baltimore, MD 21215-5817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2013 |
Last Update Date | 27/08/2013 |