Provider Demographics
NPI:1083370639
Name:ERVIN, TANAEYA ASHLEI RENAE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TANAEYA
Middle Name:ASHLEI RENAE
Last Name:ERVIN
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 1:554 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3341
Mailing Address - Country:US
Mailing Address - Phone:203-489-2870
Mailing Address - Fax:
Practice Address - Street 1:554 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3341
Practice Address - Country:US
Practice Address - Phone:203-489-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker