Provider Demographics
NPI:1578104022
Name:LIND, TAMI JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMI JO
Middle Name:
Last Name:LIND
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 1:322A BRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3715
Mailing Address - Country:US
Mailing Address - Phone:860-733-2422
Mailing Address - Fax:
Practice Address - Street 1:62 CARTER ROAD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757
Practice Address - Country:US
Practice Address - Phone:860-927-3772
Practice Address - Fax:860-327-1840
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0106951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical