Provider Demographics
NPI:1184819542
Name:MUNOZ, TAMARA M (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:M
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MYERS RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-9702
Mailing Address - Country:US
Mailing Address - Phone:317-718-8436
Mailing Address - Fax:317-718-8438
Practice Address - Street 1:202 MYERS RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9702
Practice Address - Country:US
Practice Address - Phone:317-718-8436
Practice Address - Fax:317-718-8438
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004720A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400061294Medicare PIN