Provider Demographics
NPI:1578645669
Name:LIVINGSTON, TAMARA (MA)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16561 VIA LAGO AZUL
Mailing Address - Street 2:PO BOX 8403
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-8403
Mailing Address - Country:US
Mailing Address - Phone:959-756-3269
Mailing Address - Fax:
Practice Address - Street 1:5675 RUFFIN ROAD
Practice Address - Street 2:SUITE325
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-467-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist