Provider Demographics
NPI:1467837948
Name:TAITT, TAMARA (LMFT, LM)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:TAITT
Suffix:
Gender:F
Credentials:LMFT, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16821 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2405
Mailing Address - Country:US
Mailing Address - Phone:917-309-1618
Mailing Address - Fax:
Practice Address - Street 1:16821 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2405
Practice Address - Country:US
Practice Address - Phone:786-953-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW365176B00000X
374J00000X
FLMT3049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMW365OtherCOUNCIL OF LICENSED MIDWIFERY