Provider Demographics
NPI:1942554340
Name:TAI, NYSSA JAE (LCSW, MCAP)
Entity Type:Individual
Prefix:
First Name:NYSSA
Middle Name:JAE
Last Name:TAI
Suffix:
Gender:F
Credentials:LCSW, MCAP
Other - Prefix:
Other - First Name:NYSSA
Other - Middle Name:JAE
Other - Last Name:OLNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:232 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1612
Mailing Address - Country:US
Mailing Address - Phone:407-428-5751
Mailing Address - Fax:
Practice Address - Street 1:232 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1612
Practice Address - Country:US
Practice Address - Phone:407-428-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW125791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIE922ZOtherINDIVIDUAL PRATICTITIONER LINKED TO AN ORGANIZATION