Individual provider Active NPI

Tiara Danielle Fowlkes, LMSW

  • Clinical Social Worker
  • Hunt Valley, MD
National Provider Identifier
1295507374
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
27879 Issued in MD
Practice address
11350 McCormick Rd Ste 1202
Hunt Valley, MD 21031-1002
Phone
(443) 671-4601
NPI assigned
Oct 23, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 27879 MD Primary

Addresses

Primary practice location

11350 McCormick Rd Ste 1202
Hunt Valley, MD 21031-1002

Mailing address

11350 McCormick Rd Ste 1202
Hunt Valley, MD 21031-1002
Phone (443) 671-4601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
27879MDMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1295507374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11350 MCCORMICK RD STE 1202",
            "city": "HUNT VALLEY",
            "state": "MD",
            "postal_code": "210311002",
            "telephone_number": "443-671-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11350 MCCORMICK RD STE 1202",
            "city": "HUNT VALLEY",
            "state": "MD",
            "postal_code": "210311002",
            "telephone_number": "443-671-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLKES",
        "first_name": "TIARA",
        "middle_name": "DANIELLE",
        "name_prefix": "Ms.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-23",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "27879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hunt Valley, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.