Provider Demographics
NPI:1215522511
Name:RADCLIFF, TEYNEESA (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:TEYNEESA
Middle Name:
Last Name:RADCLIFF
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MERCANTILE LN STE 100S
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5383
Mailing Address - Country:US
Mailing Address - Phone:301-246-2011
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 100S
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5383
Practice Address - Country:US
Practice Address - Phone:301-246-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26839104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker