Individual
MR. JACK NIMATALLAH TAWIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW-C
Contact information
Practice address
1831 FOREST DR, SUITE F, ANNAPOLIS, MD 21401-4430
(410) 562-9647
Mailing address
1831 FOREST DR, SUITE F, ANNAPOLIS, MD 21401-4430
(410) 562-9647
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13725
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003740U64
PTAN
MD
01
—
741421600659
CCN
MD
Enumeration date
02/29/2008
Last updated
09/19/2014
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