Provider Demographics
NPI:1720121304
Name:CEREMELLO, TANYIA LEE (MSW)
Entity Type:Individual
Prefix:MS
First Name:TANYIA
Middle Name:LEE
Last Name:CEREMELLO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:TANYIA
Other - Middle Name:LEE
Other - Last Name:CEREMELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:3300 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1451
Mailing Address - Country:US
Mailing Address - Phone:916-734-6622
Mailing Address - Fax:916-734-4150
Practice Address - Street 1:3300 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1451
Practice Address - Country:US
Practice Address - Phone:916-734-6622
Practice Address - Fax:916-734-4150
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW203681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical