Provider Demographics
NPI:1255098901
Name:BERISFORD, TANYA SUE (MSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:SUE
Last Name:BERISFORD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:FERGUSON
Other - Last Name:BERISFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3613 BREEDERS CUP CT
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-5112
Mailing Address - Country:US
Mailing Address - Phone:352-483-6498
Mailing Address - Fax:
Practice Address - Street 1:3613 BREEDERS CUP CT
Practice Address - Street 2:
Practice Address - City:GOTHA
Practice Address - State:FL
Practice Address - Zip Code:34734-5112
Practice Address - Country:US
Practice Address - Phone:352-483-6498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL140601041C0700X
FL213001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical