Provider Demographics
NPI:1235674920
Name:KENWORTHY, TAMAR MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAMAR
Middle Name:MARIE
Last Name:KENWORTHY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 N CITRUS LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5926
Mailing Address - Country:US
Mailing Address - Phone:559-253-2278
Mailing Address - Fax:
Practice Address - Street 1:5610 N CITRUS LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5926
Practice Address - Country:US
Practice Address - Phone:559-253-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21527103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist