Provider Demographics
NPI:1013023779
Name:SICARD, TAMMY GENE (IMH 4536)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:GENE
Last Name:SICARD
Suffix:
Gender:F
Credentials:IMH 4536
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-4931
Mailing Address - Country:US
Mailing Address - Phone:941-379-9111
Mailing Address - Fax:
Practice Address - Street 1:4930 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2206
Practice Address - Country:US
Practice Address - Phone:941-356-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 4536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health