Provider Demographics
NPI:1619016532
Name:PAOLILLO, TAMRA C (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:C
Last Name:PAOLILLO
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 1:137 N BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3491
Mailing Address - Country:US
Mailing Address - Phone:816-271-6573
Mailing Address - Fax:816-271-6572
Practice Address - Street 1:137 N BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3491
Practice Address - Country:US
Practice Address - Phone:816-271-6573
Practice Address - Fax:816-271-6572
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW001949104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241020OtherVALUE OPTIONS ID
MO10001309000OtherCOMMUNITY HEALTH PLAN ID
MO18524038OtherBLUE CROSS BLUE SHIELD ID