Provider Demographics
NPI:1407579337
Name:BESAW, TAMMY (MS, PLSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:BESAW
Suffix:
Gender:F
Credentials:MS, PLSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FOXCROFT AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-5341
Mailing Address - Country:US
Mailing Address - Phone:304-596-2390
Mailing Address - Fax:304-596-2392
Practice Address - Street 1:300 FOXCROFT AVE STE 307
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-5341
Practice Address - Country:US
Practice Address - Phone:304-596-2390
Practice Address - Fax:304-596-2392
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPL022216143104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker