Provider Demographics
NPI:1003121211
Name:DESARMO, TANYA (LCSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:DESARMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 S BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-8914
Mailing Address - Country:US
Mailing Address - Phone:920-459-9277
Mailing Address - Fax:920-459-7920
Practice Address - Street 1:5934 S BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-8914
Practice Address - Country:US
Practice Address - Phone:920-459-9277
Practice Address - Fax:920-459-7920
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127236121104100000X
WI7843-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker