Individual
MISS IASIA TYRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSWC
Contact information
Practice address
2625 ISLAND GROVE BLVD, FREDERICK, MD 21701-3313
(718) 775-1992
Mailing address
2625 ISLAND GROVE BLVD, FREDERICK, MD 21701-3313
(718) 775-1992
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
17900
MD
Other
Enumeration date
06/28/2015
Last updated
05/14/2024
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