Provider Demographics
NPI:1881856870
Name:GREENWOOD, TANIA ZOHAIR (MSW)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:ZOHAIR
Last Name:GREENWOOD
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 1:1236 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2607
Mailing Address - Country:US
Mailing Address - Phone:714-995-1000
Mailing Address - Fax:
Practice Address - Street 1:1236 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2607
Practice Address - Country:US
Practice Address - Phone:714-995-1000
Practice Address - Fax:714-828-7926
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMSW191210Medicaid