Provider Demographics
NPI:1518309822
Name:BARKLEY-GRAHAM, TANYA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:A
Last Name:BARKLEY-GRAHAM
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 1:2161 HARBOURSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-4271
Mailing Address - Country:US
Mailing Address - Phone:252-256-3023
Mailing Address - Fax:
Practice Address - Street 1:630 S ORANGE AVE STE 302-C
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7504
Practice Address - Country:US
Practice Address - Phone:252-489-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW131381041C0700X
NCC0067981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical