Provider Demographics
NPI:1740354687
Name:STAPLES, TAMMY LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:STAPLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3311 NW 69TH COURT
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1204
Mailing Address - Country:US
Mailing Address - Phone:860-874-2484
Mailing Address - Fax:954-851-9688
Practice Address - Street 1:3311 NW 69TH COURT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1204
Practice Address - Country:US
Practice Address - Phone:860-874-2484
Practice Address - Fax:954-851-9688
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0044171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00423734400Medicaid