Provider Demographics
NPI:1588322234
Name:TALAMAIVAO, CARRIE (LICSW)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:TALAMAIVAO
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 1:20413 SE 261ST PL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-6109
Mailing Address - Country:US
Mailing Address - Phone:813-909-6966
Mailing Address - Fax:
Practice Address - Street 1:20413 SE 261ST PL
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-6109
Practice Address - Country:US
Practice Address - Phone:813-909-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW612126971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical