Provider Demographics
NPI:1477003390
Name:SAINT GILLES, TAMARA
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SAINT GILLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 NE 132ND TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3921
Mailing Address - Country:US
Mailing Address - Phone:305-710-2390
Mailing Address - Fax:
Practice Address - Street 1:7811 CORAL WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6540
Practice Address - Country:US
Practice Address - Phone:305-710-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW109951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical