Individual
BRENDA ODALYS TAVARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
220 GIRARD ST # 100, GAITHERSBURG, MD 20877-3467
(301) 216-0880
(301) 495-0318
Mailing address
8630 FENTON ST STE 1204, SILVER SPRING, MD 20910-3808
(240) 839-5811
(301) 495-0318
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
25911
MD
1041C0700X
Clinical Social Worker
Primary
25911
MD
Other
Enumeration date
06/30/2020
Last updated
06/30/2020
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