Provider Demographics
NPI:1528581485
Name:BYRD, TAMANIQUE (LICSW)
Entity Type:Individual
Prefix:
First Name:TAMANIQUE
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3396
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06083-3396
Mailing Address - Country:US
Mailing Address - Phone:860-922-2362
Mailing Address - Fax:
Practice Address - Street 1:5 WESTVIEW DR. APT E
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-7004
Practice Address - Country:US
Practice Address - Phone:860-368-8905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3759101YM0800X
MA1233521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health