Provider Demographics
NPI:1780717140
Name:TRAGER, TAMARA (LBSW)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:TRAGER
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12217 TWIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3706
Mailing Address - Country:US
Mailing Address - Phone:512-461-8671
Mailing Address - Fax:
Practice Address - Street 1:12217 TWIN CREEK RD
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3706
Practice Address - Country:US
Practice Address - Phone:512-461-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS21249104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182337901Medicaid