Provider Demographics
NPI:1194809665
Name:OAKLEY, TINA M (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:M
Last Name:OAKLEY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:GRAZULIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:106 MILFORD STREET #104
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-543-8290
Mailing Address - Fax:410-341-6275
Practice Address - Street 1:106 MILFORD STREET #104
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-543-8291
Practice Address - Fax:410-341-6275
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405753800Medicaid
MD118P317GMedicare PIN
MDQ54116Medicare UPIN