Provider Demographics
NPI:1124588504
Name:BRICE, TANYA (LBSW)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:BRICE
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PAINTERS MILL RD STE 213
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5543
Mailing Address - Country:US
Mailing Address - Phone:443-898-6128
Mailing Address - Fax:
Practice Address - Street 1:110 PAINTERS MILL RD STE 213
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5543
Practice Address - Country:US
Practice Address - Phone:443-898-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13808104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1649747528Medicaid