Provider Demographics
NPI:1922245422
Name:SVENSON, TAMMY PAULUS (LICSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:PAULUS
Last Name:SVENSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WHIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1343
Mailing Address - Country:US
Mailing Address - Phone:207-351-5116
Mailing Address - Fax:
Practice Address - Street 1:201 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1343
Practice Address - Country:US
Practice Address - Phone:207-351-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical