Healthcare Provider Details

I. General information

NPI: 1285475673
Provider Name (Legal Business Name): TAMARA HARDCASTLE STICKLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 EARDLEY AVE
PACIFIC GROVE CA
93950-3631
US

IV. Provider business mailing address

329 EARDLEY AVE
PACIFIC GROVE CA
93950-3631
US

V. Phone/Fax

Practice location:
  • Phone: 831-915-5848
  • Fax:
Mailing address:
  • Phone: 831-915-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: