Provider Demographics
NPI:1639835200
Name:DWYER, TAMARA SUE (PLMHP, PCMSW, LMSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:SUE
Last Name:DWYER
Suffix:
Gender:F
Credentials:PLMHP, PCMSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 POLK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-4451
Mailing Address - Country:US
Mailing Address - Phone:402-208-0621
Mailing Address - Fax:
Practice Address - Street 1:9308 POLK ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-4451
Practice Address - Country:US
Practice Address - Phone:402-208-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095642104100000X
NE76271041C0700X
NE126231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker