Provider Demographics
NPI:1871657494
Name:GREENE, TAMARA (MSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4772
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33677-4772
Mailing Address - Country:US
Mailing Address - Phone:813-247-5433
Mailing Address - Fax:813-241-4297
Practice Address - Street 1:209 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1333
Practice Address - Country:US
Practice Address - Phone:813-247-5433
Practice Address - Fax:813-247-5433
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW3700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISW3700OtherSOCIAL WORK INTERN