Provider Demographics
NPI:1275969065
Name:WARREN, TAMARA MARGARET (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:MARGARET
Last Name:WARREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1299 BEDFORD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1900
Mailing Address - Country:US
Mailing Address - Phone:321-259-1662
Mailing Address - Fax:321-259-1223
Practice Address - Street 1:1299 BEDFORD DR
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1900
Practice Address - Country:US
Practice Address - Phone:321-259-1662
Practice Address - Fax:321-259-1223
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5630103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist