Provider Demographics
NPI:1013407089
Name:FLEMING, TAMARA MARIE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARIE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:MARIE
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3500 HAMMOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1483
Mailing Address - Country:US
Mailing Address - Phone:916-524-4189
Mailing Address - Fax:
Practice Address - Street 1:3500 HAMMOCK AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1483
Practice Address - Country:US
Practice Address - Phone:916-524-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
103K00000X, 104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker