Provider Demographics
NPI:1033537626
Name:TAVARES, DEEMARLA (LMSW)
Entity Type:Individual
Prefix:
First Name:DEEMARLA
Middle Name:
Last Name:TAVARES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 IRONWOOD PL
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2670
Mailing Address - Country:US
Mailing Address - Phone:208-769-4222
Mailing Address - Fax:208-667-7557
Practice Address - Street 1:2201 IRONWOOD PL
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2670
Practice Address - Country:US
Practice Address - Phone:208-769-4222
Practice Address - Fax:208-667-7557
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-307601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical