Provider Demographics
NPI:1982796371
Name:TAMMINEN, PAUL GUSTAV (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GUSTAV
Last Name:TAMMINEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7860 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3245
Mailing Address - Country:US
Mailing Address - Phone:707-823-9950
Mailing Address - Fax:
Practice Address - Street 1:435 PETALUMA AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4277
Practice Address - Country:US
Practice Address - Phone:707-823-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS141301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical