1194288431 NPI number — DR. TAWNY MEAGAN EPPERSON PHD, LCPC, CT

Table of content: DR. TAWNY MEAGAN EPPERSON PHD, LCPC, CT (NPI 1194288431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194288431 NPI number — DR. TAWNY MEAGAN EPPERSON PHD, LCPC, CT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EPPERSON
Provider First Name:
TAWNY
Provider Middle Name:
MEAGAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LCPC, CT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBINSON
Provider Other First Name:
TAWNY
Provider Other Middle Name:
MEAGAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LCPC, CT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194288431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4940 EASTERN AVENUE
Provider Second Line Business Mailing Address:
COMMUNITY PSYCHIATRY PROGRAM
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21224-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-550-0067
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 E LOMBARD STREET
Provider Second Line Business Practice Location Address:
COMMUNITY PSYCHIATRY, CHILD MOBILE TREATMENT SERVICES
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-550-0067
Provider Business Practice Location Address Fax Number:
410-550-8288
Provider Enumeration Date:
04/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LC4069 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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