Provider Demographics
NPI:1821694134
Name:PATTERSON, TAHIRAH NA'ILAH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAHIRAH
Middle Name:NA'ILAH
Last Name:PATTERSON
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 1:1942 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-9137
Mailing Address - Country:US
Mailing Address - Phone:407-728-1710
Mailing Address - Fax:
Practice Address - Street 1:10967 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4457
Practice Address - Country:US
Practice Address - Phone:407-276-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW222241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical