Provider Demographics
NPI:1356487110
Name:GAVIN, TAMARA DILLON (MSW)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:DILLON
Last Name:GAVIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 S 56TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5121
Mailing Address - Country:US
Mailing Address - Phone:402-437-8853
Mailing Address - Fax:402-437-8858
Practice Address - Street 1:4141 S 56TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5121
Practice Address - Country:US
Practice Address - Phone:402-437-8853
Practice Address - Fax:402-437-8858
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8195101YM0800X
NE65421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical