Provider Demographics
NPI:1669605838
Name:TISKA CATON, CAMI L (LCSW)
Entity type:Individual
Prefix:
First Name:CAMI
Middle Name:L
Last Name:TISKA CATON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAMI
Other - Middle Name:LYNN
Other - Last Name:TISKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3800 W BROWARD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1018
Mailing Address - Country:US
Mailing Address - Phone:954-587-1008
Mailing Address - Fax:549-789-2833
Practice Address - Street 1:3800 W BROWARD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1018
Practice Address - Country:US
Practice Address - Phone:954-587-1008
Practice Address - Fax:954-587-0080
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009-90-3800Medicaid