Provider Demographics
NPI:1013444025
Name:HENDERSON, TAMARA THOMAS (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:THOMAS
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 ORANGE TREE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-3313
Mailing Address - Country:US
Mailing Address - Phone:386-451-6840
Mailing Address - Fax:
Practice Address - Street 1:1717 ORANGE TREE DR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-3313
Practice Address - Country:US
Practice Address - Phone:386-451-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker