Provider Demographics
NPI:1063023562
Name:TAMARA GILARSKI, LCSW, RPT-S, LLC
Entity Type:Organization
Organization Name:TAMARA GILARSKI, LCSW, RPT-S, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST, PLAY THERAPIST/SUP
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GILARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RPT-S
Authorized Official - Phone:772-285-7245
Mailing Address - Street 1:413 SW MAGNOLIA CV
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2325
Mailing Address - Country:US
Mailing Address - Phone:772-285-7245
Mailing Address - Fax:772-340-7214
Practice Address - Street 1:1850 SW FOUNTAINVIEW BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3443
Practice Address - Country:US
Practice Address - Phone:772-285-7245
Practice Address - Fax:772-340-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407997729Medicaid