Provider Demographics
NPI:1376215863
Name:TYNES, JOSEPHINE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:MARIE
Last Name:TYNES
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 1:21286 FALLS RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4870
Mailing Address - Country:US
Mailing Address - Phone:407-484-6244
Mailing Address - Fax:
Practice Address - Street 1:21286 FALLS RIDGE WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4870
Practice Address - Country:US
Practice Address - Phone:407-484-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW156261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW15626OtherFLORIDA DEPARTMENT OF HEALTH