Basic Information
| Provider Information | |||||||||
| NPI: | 1942646088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAFT | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | DOLORES | ||||||||
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| Credential: | LGSW, CAC-AD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3323 LYNDALE AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212131609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103278109 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 421 FALLSWAY | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212024800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108375533 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2013 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | AC1718 | MD | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 17226 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.