Healthcare Provider Details

I. General information

NPI: 1336698737
Provider Name (Legal Business Name): TAMARA L STEWART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6529 BIMINI CT
APOLLO BEACH FL
33572-2106
US

IV. Provider business mailing address

6529 BIMINI CT
APOLLO BEACH FL
33572-2106
US

V. Phone/Fax

Practice location:
  • Phone: 813-454-5917
  • Fax:
Mailing address:
  • Phone: 813-454-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13601
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: