Healthcare Provider Details

I. General information

NPI: 1285046201
Provider Name (Legal Business Name): TAMARA WALKER-GLADNEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2014
Last Update Date: 04/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 S STATE ST
DOVER DE
19901-7314
US

IV. Provider business mailing address

156 S STATE ST
DOVER DE
19901-7314
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2380
  • Fax:
Mailing address:
  • Phone: 302-674-2380
  • Fax: 302-674-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberB1-0000616
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: