Provider Demographics
NPI:1164033080
Name:CLEVENGER, TAMMY J (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7590 GRADY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-2470
Mailing Address - Country:US
Mailing Address - Phone:239-672-6600
Mailing Address - Fax:
Practice Address - Street 1:215 W VERNE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2324
Practice Address - Country:US
Practice Address - Phone:239-672-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW143511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical