Provider Demographics
NPI:1578795654
Name:WINER, TAMARA SUBOTNICK (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:SUBOTNICK
Last Name:WINER
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 1:14006 OTSEGO ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1225
Mailing Address - Country:US
Mailing Address - Phone:818-257-4120
Mailing Address - Fax:
Practice Address - Street 1:4405 W RIVERSIDE DR
Practice Address - Street 2:SUITE #106
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4072
Practice Address - Country:US
Practice Address - Phone:818-257-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16320104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker