Provider Demographics
NPI:1912571068
Name:WALDEN, TAMARA TASHIKO (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:TASHIKO
Last Name:WALDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 SILVERWEED WAY
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4621
Mailing Address - Country:US
Mailing Address - Phone:352-398-2136
Mailing Address - Fax:
Practice Address - Street 1:1947 SILVERWEED WAY
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4621
Practice Address - Country:US
Practice Address - Phone:352-398-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9910103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling