Provider Demographics
NPI:1245924364
Name:TRAVIS, TAMARA RENEE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:RENEE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:RENEE
Other - Last Name:SMALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1111 BENFIELD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3004
Mailing Address - Country:US
Mailing Address - Phone:443-256-9237
Mailing Address - Fax:
Practice Address - Street 1:1111 BENFIELD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-3004
Practice Address - Country:US
Practice Address - Phone:443-256-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD288931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical